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FLUORIDATION
drinking water. Washington, D.C. Government Printing office. July, 1952. See also reference No. 2. 39. American Institute of Baking. The effect of fluoride in dough water upon bread quality. Special. Bulletin. Chicago, July 6, 1950. 40. Doty, J. R. and Phair, W. P. An analysis of the Delaney Committee report on the fluoridation of drinking water: J.A.D.A. 45:351, Sept. 1952. 41. The American Dental Association Council on Dental Health. An analysis of the statements by Rep. A. L. Miller which appear in the Congressional Record March 24 and May 7, 1952. (Mimeog.) 42. Fluoridation's Fine. Chemical and Engineering News, 30:4458, Oct. 27, 1952. 43. Alexander, Leo. Letter to Dr. A. Gold, Feb. 4, 1952. News Letter Council on Dental Health, A.D.A. 8:2, June, 1952. 44. Frisch, J. G. Personal communication to W. Philip Phair, April 7, 1952. 45. Pearlman, S. Untested alternatives to fluoridation of domestic water supplies. J.A.D.A. 46:287 -289, March 1953. 46. Galagan, D. J. and Lamson, G. G. Climate and endemic fluorosis. Pub. Health Rep. 68:497 -508, May, 1953. 47. Weir, W. V. Considerations_ in supplying fluoridated water to industry. J.A.W.W.A. 45:369 -375, April 1953. 48. Smith, F., Gardner, D. E. and Hodge, H. C. Investigation on metabolism of fluoride. II. Fluoride content of blood and urine as a function of the fluorine in drinking water. J. Dent. Res. 29:5% -600, Oct. 1950. 49. Galagan, D. J. Climate and controlled fluoridation. J.A.D.A. 47:159.170, Aug. 1953. 50. Furet, J. H., Aluminum Company of America, personal communication to David J. Smith, D.D.S., May 19, 1955. 51. Dean, H. T. Fluorine in the control of dental caries. J.A.D.A. 52:1.8, Jan. 1956. 52. Held, A. J. and Demole, V. Fluor et sante generale: etat de sante de la population autochtone et immigree du village de Sembrancher (Fluorine and general health: state of health of the native and immigrant population of the village of Sembrancher). Schweizerische Medizinische Wochenschrift (Basel) 83:362, April 11, 1953. 53. Leone, N. C., Shimkin, M. B., Arnold, F. A. Jr., Stevenson, C. A., Zimmer- man, E. R., Geiser, P. B. and Lieberman, J. E. Medical aspects of excessive fluoride in a water supply.' Pub. Health Rep. 69:925 -936, Oct. 1954. 54. Newburgh- Kingston caries - fluorine study: Final Report. Hilleboe, Herman E. History of the Newburgh- Kingston caries - fluorine study. Schesinger, Edward R., Overton, David E., Riverhead, L.I., Chase, Helen C. and Cantwell, Katherine T. Newburgh- Kingston caries - fluorine study. XIII. Pediatric Findings after ten years. Hodge, Harold C. Fluoride Metabolism: Its significance in water fluoridation. Ast, David 'B., Smith, David J'., Wachs, Barnet and Cantwell, Katherine T. Newburgh- Kingston caries - fluorine study XIV. Combined clinical and roentgen- ographic dental findings after ten years of fluoridation experience. J.A.D.A. 52:290 -325. March 1956. 55. Lull, G. F. Fluoridation of water supplies, Today's Health, June, 1955. 56. Cameron, Charles S., President American Cancer Society. Personal communi. cation to Dr. Tom M. Oliver, Waco, Texas. April 10, 1953. 57. Hagan, T. L. and others. Waterborne fluoride and mortality. Pub. Health Rep. 69:450, May 1954. 23 671 -MM -536 MM® IN USA. I n �i 4 FLUORIDATION FACTS ANSWERS TO CRITICISMS OF FLUORIDATION AMERICAN DENTAL ASSOCIATION • APRIL 1956 CONTENTS Subject and section no. Subject and section no. Acne 11 Industry 8, 10, 12, 33, 36, 40 Adults, Benefits to 15 Ingestion 7 Aluminum 12 Insecticides 2 Arteries, Hardening of 8 Internal organs, Effect on 6, 37 "Artificial" VS. Kidneys, Effect on 7 Natural 14, 16, 35 Liability of water works 32 Benefits 1, 14, 15 Liability of food processors 36 Bones, Brittle 9, 10 Magnesium 29 Cancer 3 "Medication" 21, 23, 24, 25 Caries reduction 14 - - Mottled enamel 4 ' Cattle, Effect on 10 Chlorination 2, 23, 24 National health - Climate factor 5 organizations 1, 20, 34 Compulsory 25 Nephritis 7, 37 Concentration, Recommended 5 Nuremberg war crimes 22 Consumption, Individual 28 Nutrition 42 Cost 18, 19 Operating problems 31 Decay: see caries "Overdosage" Delaney Report 39 possibilities 26, 27 Elimination 7 Periodontal disease 43 Enamel, "Mottled" 4 Physiological effect 1, 35, 41 Endemic areas 3 "Poisonous substance" 2 Endorsements 1, 2; 20, 34, 38 Policies, Favorable 1, 20; 34, 38 Engineering problems 30 Enzymes 45 "Rat poison" 2 "Experimental" status 14 Referendum 13 Research 14, 34, 38, 40, 41 Feeders, Fluoride 31 Final knowledge 44 Socialized medicine 24 Foods 17, 36, 40 Staining of teeth 4, 5 Freedom of religion 21 "Toxicity" 1 Hardening of arteries 8 "Harmful" effects 1, 37, 41 Vital statistics 3, 7, 37, 41 Hazard to workers 31 "Wasteful" 19 Ice production, ,Effect on 33 Individual variation 28, 41 X -ray examinations 9 References P. 19 1 18. Knutson, J. W. Important questions answered. Material prepared by commit- tees of dental health workshop, public relations, and dental health, Tenn. State Dent. Assoc., Nashville, Jan. 19, 1952. 19. McClure, F. J. Fluoride domestic waters and systemic effects. I. Relation to bone fracture experience, height and weight of high school boys and young selectees of the Armed Forces of the United States. Pub. Health Rep. 59:1543, Dec. 1, 1944. 20. Hodges, P. C., Fareed, 0. J., Ruggy, G. and Chudnoff, J. S. Skeletal sclerosis in chronic sodium fluoride poisoning. J.A.M.A. 117:1938, Dec. 6, 1941. - 21. Epstein, Ervin. Effects of fluorides in acne vulgaris. Stanford Medical Bulle- tin, Dept. of Med., Div. of Dermatology, Stanford Univ. School of Med. 9:243, Nov. 1951. - - 22. Pickett, A. R., Aluminum Co. of America. Personal communication to Sey- mour Standish, executive sec'y., Wash. State Health Council. Dec. 31, 1951. 23. Dorland, W. A. The American illustrated medical dictionary. Philadelphia, W. B. Saunders Co., 1947, p. 856. 24. Zufelt, J. C. Experience with fluoridation of drinking water. Sheboygan ex. perience, J.A.W.W.A. 42:839, Sept. 1950. 25. Waldrep, Burnell. Municipal liability in damage suits from fluoridation. J.A.W.W.A. 44:10, Jan. 1952. 26. Bull, F. A., Hardgrove, T. A. and Frisch, J. G. Methods and costs of water fluoridation. J.A.D.A. 42:29, Jan. 1951. 27. Drink away tomorrow's tooth decay. U.S.P.H.S. Publication No. 72, 1951. 28. Russel, A. L. and Elvove, Elias. Domestic water and dental caries. VII. A study of the fluoride - dental caries relationship in an adult population. Pub. Health Rep. 66:1389, Oct. 26, 1951. 29. Cox, Charles R. and Ast, David B. Water fluoridation —a sound public health practice. J.A.W.W.A. 43:641, Aug., 1951. 30. Questions and answers on fluoridation of public water supplies. Willing Water, A.W.W.A., Vol. 14, April, 1951. 31. Statement of Inter - Assoc. Com. on Health, Feb. 1, 1952. 32. Studies show magnesium does not interfere with dental effect of water -borne fluorides. News Letter, Council on Dental Health, A.D.A. 7:7, Dec., 1951. 33. Plater, W. R. caries control: its influence and effects on malocclusion. Am. J. Orthodont. 35:790, Oct., 1949. 34. Cox, G. J. Evaluation of methods of caries prevention and control. J. Wis. State Dent. Soc. 27:185, Nov., 1951. 35. Mortality in fluoride and non - fluoride areas. Illinois Health Statistics Bulle- b tin. Special Release No. 20, State Health Dept., Springfield, Apr. 1, 1952. 36. Frye, H. R. and Hill, I. N. Water fluoridation and dental research. -, J.A.W.W.A., 44:947, Oct. 1952. t 37. Hearings before House Select Committee to investigate the use of chemicals in foods and cosmetics. Part 3. (Jan. 10-March 6, 1952) Washington, D.C. Government Printing office, 1952. , 38. House of Representatives. Report No. 2500, Union Calendar No. 787. Investiga- tion of the use of chemicals in foods and cosmetics. Fluoridation of public 22 REFERENCES 1. Hill, I. N., Jelinek, 0. E., and Blayney, J. R. The Evanston dental caries study. III. A preliminary study of the distribution of fluorine in communal water supplies in the United States. J. Dent. Res. 38:398, Aug. 1949. 2. American Medical Association. Joint statement of Council on Pharmacy and Chemistry and Council on Foods and Nutrition. J.A.D.A. 43:733, Dec. 1951. Resolution, A.M.A. Hse. of Delegates, J.A.M.A. 148:1130, March 29, 1952. 3. Taylor, Edward, Facts relative to rumors that fluoridation is harmful. Texas D. J. 69:381, Sept. 1951. 4. Federal Security Agency Dental News. Issue No. 23, Dec. 1951. 5. Wisconsin State Board of Health. Continuous - resident data, 1951: Death rates per 100,000 population in cities with varying concentrations of fluorides in public water supplies 1945 -49. Death rates in cities with varying concentra- tions of fluorides in public water supplies 1940 -44. 6. McClure, F. J. Ingestion of fluoride and dental caries. Quantitative relations based on food and water requirements of children one to twelve years old. Am. J. Dis. Child. 66:362, Oct. 1943. 7. McClure, F. J., Mitchell, H. H., Hamilton, T. S., and Kinser, C. A. Balances of fluorine ingested from various sources in food and water by five young men. Excretion of fluorine through the skin. J. Indus. Hyg. and Toxicol. 27:159, 1945. 8. Cox, G. J. and Hodge, H. C. The toxicity of fluorides in relation to their use in dentistry. J.A.D.A. 40:440, April 1950. 9. Dean, H. T. The investigation of physiological effects by the epidemiological method. In Fluorine and Dental Health, Moulton, F. R., editor. Lancaster, Pa. American Association for the Advancement of Science, 1942. 10. McClure, F. J. Nondental physiological effects of trace quantities of fluorine. In Fluorine and Dental Health,. Moulton, F. R., editor. Lancaster, Pa. Ameri- can Association for the Advancement of Science, 1946. 11. Roholm, K. Fluorine intoxication. London, H. K. Lewis & Co., Ltd., 1937. 12. Machle, W. and Largent, E. J. The absorption and excretion of fluorides. II. The metabolism at high levels of intake. J. Indus. Hyg. & Toxicol. 25:112, 1943. Chem. Abstracts 37:6032, 1943. 13. Leone, N. C., Stevenson, Clyde, A., Hillbish, Theo. F. and Sosman, Merrill C. A roentgenologic study of human population exposed to high fluoride domestic water. A ten year study. The American Journal of Roentgenology, Radium Therapy and Nuclear Medicine. Vol. LXXIV, No. 5, Nov. 1955. 14. Smith, F. A. An annotated bibliography of the literature on the pharmacology and toxicology of fluorine and its compounds. University of Rochester, Atomic Energy Project, Jan. 29, 1951. 15. Schlesinger, Edward R., Overton, David E., and Chase, Helen C., "Newburgh - Kingston caries fluorine study. II. Pediatric aspects - preliminary report, J. Pub. Health and the Nation's Health 40:725, June 1950. 16. Maier, F. J. Fluoridation of public water supplies. J.A.W.W.A. 42:1120, De- cember 1950. 17. Levin, Margaret M. and Cox, Gerald J. Water Consumption in relation to environmental temperature and its significance in the fluoridation of water supplies. J. Dent. Res. 29:663, Oct. 1950. 21 The assertion: 1. Fluorides in the public water supply may have a harmful effect on human beings. The fact: For generations over 4,000,000 people in the United States have been living all their lives in areas where the drinking water naturally con - tains fluorides in concentrations as high as or higher than that recom- mended for dental health.' ° Many studies have been conducted among these people by competent investigators and the search has been pains- taking, yet no one has been able to find any adverse physiological effect except an enamel defect known as dental fluorosis in areas where the fluoride concentration is too high.53 Every national health organization in the United States that speaks with authority on the benefits and safety of fluoridation has adopted policies favorable to the. measure. The House of Delegates of the American Medical Association has passed a resolution endorsing fluoridation, citing the joint statement of the A.M.A. Councils on Pharmacy and Chemistry and on Foods and Nutrition that there is no evidence of toxicity that should raise any question against the fluoridation of public water supplies .2, 55 l Other national organizations that have endorsed fluoridation include: American Dental Association, American Association of Public Health Dentists, Association of State and Territorial Dental Directors, Associa- tion of State and Territorial Health Officers, National Research Council, U. S. Public Health Service, American Association for .the Advancement of Science, American Academy of Pediatrics, Commission on Chronic Illness, Inter - Association Committee on Health, American Society of Dentistry for Children, American Public Health Association, American Academy of Dental Medicine, Canadian Dental Association, Canadian Medical Association, Canadian Public Health Association, International Dental Federation, Australian Dental Association, American Pharma- ceutical Association, National Congress of Parents and Teachers, Amer- ican Federation of Labor and Congress of Industrial Organizations, American Legion and U. S. Junior Chamber of Commerce. The assertion: 2. Fluorine is a poisonous substance found in rat poison and insecti• tides. The fact: This assertion is true, but the inference that the same substance in mi- nute concentration in drinking water has the same effect as fluorine in high concentrations is completely incorrect. Many substances in com- •References begin on page 19. mon use by human beings are beneficial when used in proper amounts but may be harmful when used improperly. For example, chlorine is used also in most public drinking waters in the United States. Sodium chloride is also, poisonous in large amounts yet it is ordinary table salt. The assertion: 3. Fluorides cause or accelerate the growth of cancer. The fact: This statement has been made as a result of wide publicity given to a mouse cancer experiment conducted by a biochemist at the University of Texas. A report in the Texas Dental Journal in September 1951 showed that while the biochemist was feeding, forty -four one hundredths of a part fluorine per million parts water, he was unintentionally giving an additional 42 ppm (parts per million) fluorine that was contained in dog, chow, the exclusive diet of the mice.3 Moreover, it was noted that the mice used in the experiment were a special strain, highly inbred for susceptibility to mammary tumors. Approximately 96 -100% of these mice eventually succumb to mammary tumors regardless of the diet and the water. Two authorities from the United States Public Health Service visited the University of Texas and investigated the experimental work of the biochemist. They reported that there was no evidence that would go against the recommendation for the fluoridation of public water supplies. Dr. Charles . S. Cameron, President of the American Cancer Society, stated in a letter to Dr. Tom M. Oliver of Waco, Texas: "No valid scien- tific evidence known to the society supports a causative relationship of fluorine (specifically in amounts used in water fluoridation for the pur- pose of dental caries prophylaxis) to cancer. On the contrary such epi- demiological and laboratory experimental data as are available indicate no such relationship." " Additional information on this subject is provided in the records of bureaus of vital statistics in various states. The statistics indicate that cancer rates are lower in states where there are many natural fluoride areas than in states where the waters are fluoride- free.3, 4 There is no reason to believe, however, that these lower cancer rates are due to the presence of fluorides in drinking water. The assertion: 4. Fluorides cause an unsightly staining of the teeth. The fact: It is a well known fact that high concentrations of fluorides found natu- rally in public: water supplies may lead to a condition known as dental The assertion: 45. Inorganic fluorides inhibit essential enzyme functions in humans. The fact: This statement is typical of the half - truths that are frequently employed by opponents of fluoridation. The critical consideration here is the fact that this statement does not specify in any way the amount or concentration of fluoride. In relatively high concentration fluorides may inhibit a number of enzymatic processes as measured outside the body. However, there is no evidence that the ingestion of drinking.water containing 1 ppm fluoride will lead to a concentration of fluoride in any tissue of the body which will adversely affect the enzyme systems of that tissue. The ability of the kidneys to excrete fluoride and of the bones to store fluoride without injury provides a means whereby the concentration of fluoride in the blood is maintained at an extremely low level. 48 There has, furthermore, been no demonstration that fluor- ide ions at a concentration of 1 ppm in water will adversely affect any enzyme used in a fermentation or other industrial process. 20 The studies are not confined to death rates, but are concerned with many aspects of health. The clinical examination of a few individuals will often fail to disclose effects that become apparent when the examinations are extended_ to a large group. Nevertheless, even in studies where population groups were subjected naturally to a much higher concentration of fluoride than would be used in a clinical test, there was no evidence of harmful effect in any individual from the fluorides ingested. There is, it is true, dental fluorosis where water containing relatively high concentrations of fluor' ides is consumed, but it is emphatically not the case where the water contains the recommended 1.0 -1.5 ppm fluorine.52. 53, 54, 13 The assertion: 42. No one to date has given proof that fluorine is essential to nutri- tion. The fact: No one has demonstrated that fluorine is or is not essential to animal life, since no one has been able to obtain an adequate diet thaf is com- pletely devoid of fluorine. This point, however, has no real bearing. on the question of fluoridation. Consumption of a suitable amount of fluor- ide throughout the period of tooth formation leads' to the development of teeth that are more resistant to decay than they would otherwise be. The assertion: 41 Fluoridation will not do any permanent good because teeth saved from decay by fluoride will later be lost through increased perio- dontal disease caused by the fluorides. The fact: This assertion has been directly disproved in a study which. showed that' adults in a non-'fluoride area lost three to four times as many teeth as did persons of the same age in.a' fluoride area. 28 The assertion: 44. Fluoridation should not be undertaken because we do not yet have .final knowledge of the effects of fluorides on humans. The fact: I . In science .there is no such thing as final knowledge., New information is continuously being brought forth even on such accepted procedures as pasteurization of milk and chlorination of water, All evidence, on fluoridation, however, as on these. other procedures, attests the safety and effectiveness of the measure for the partial control of dental caries. 19: fluorosis, often called mottled. enamel. In such areas, the degree of dental fluorosis may., be such that the dental_ enamel readily picks up stains which discolor the teeth. Where the drinking water contains a concentration of 1 ppm fluorine, there is evidence of a very mild degree of dental fluorosis in less than 109c' of - children using, such water; however, this degree of dental fluorosis does not cause staining.° It can be detected only by dentists with special training and experience in recognizing such slight degrees as are present. In fact, many dentists believe that the increased white- ness associated with 1 ppm fluorine in drinking water actually enhances the beauty, of the teeth. 33, 34` The advantage of, fluoridation is that the development of decay- resistant teeth is promoted . without the staining of the teeth. The assertion: 5. Even 1 ppm fluorine in water causes staining of teeth in some parts of the country. The .fact: Because water intake varies to a significant extent in relation to climate and humidity factors, health authorities recommend that the concentra- tion of fluorine in public water supplies be adjusted accordingly. 17. 48, 49 The amount of fluorine required in hot, dry climates may be less than Lppm,_and,_in_other_ areas,, a_little_more_than_1_ppm_ may_ be required for optimum benefits. However, for the.majority of communities in the United States, concentration of 1 ppm is generally recommended... The amounts of fluorides necessary to control tooth decay in any region would always be less than that which would cause staining. The assertion: 6. Fluorides added to public water supplies will do untold damage to the internal organs of adults. The fact: Persons who raise such "warnings" have no evidence on which to base their charge. 8-15 Those who make unsubstantiated ,statements on harm- ful effects should be challenged to bring forth facts to support their con- tentions. Actual observations of individuals who have lived up to 70 years or more in areas where water has a high concentration of .fluoride have not revealed injuries to the internal organs.53 The assertion: 7. Fluorides accumulating in the.body will have a .harmful effect.on the kidneys of adults. 4 The fact: A review of the vital statistics available from state boards of health, such as in Illinois and Wisconsin, reveals no difference in the data on nephritis in different cities with varying amounts of. fluorides in their public water supplies.5, 35, 57 - - It is estimated that the amount of fluorine ingested daily through drink- ing water containing 1 ppm fluorine is from 0.5 to 1.0 mg.0 It has also been shown that when the total amount of fluorine ingested by adults does not exceed 4.0 to 5.0 mg. daily, its elimination in the urine, per. spiration and fecal excretion is virtually complete.? The ability of the body to handle fluorides is thus more than adequate for the amount ingested through fluoridated water. -The assertion: 8. Fluorides are used by industry as hardening agents and will also cause hardening of the arteries. The fact: This conclusion is based on a complete lack of understanding of the chemical and physiological actions of fluorides. 14 The word "harden- ing" as it applies in industry is entirely different from "hardening" applied to the physiological process of calcification of the arteries. The assertion: 9. Fluorides in the water make bones brittle. . The fact: A detailed study of 1,458 high school boys in seven cities with varying concentrations of fluorides in the public water supplies showed no effect on bone fracture experience.19 A radiologic survey at Bartlett, Texas, where the water contains 8 ppm, .revealed an increased bone density in 117c of those examined. However, this condition was not associated with functional impairment.13 X -ray, examinations of ,persons living in areas where the water contains from 1.2 to 3 ppm fluorine revealed no evidence of bone fluorosis.20 The assertion: 10. Fluorides weaken the bones of cattle. The fact: It has been reported that in some industrial areas, fluoride - bearing dust from some manufacturing plants has laid a heavy coating of the mate- rial over nearby pasture lands. Cattle grazing in these areas have there- fore consumed.large quantities of fluorides and have suffered ill effects. Dust control measures have been taken. to prevent further such occur- rences. It is dangerously misleading, however, to compare the effects The fact: In the early years of controlled fluoridation there was some hesitancy on the part of food and beverage processors about . possible bad effects on their products from changes in the water supply. The weight of evidence now available from the experience of these industries in areas where the water contains fluorides, either as an incidental occurrence or in controlled amounts, shows that there is no harmful effect from fluorides present in the water supplies in 'concentrations recommended for dental health. 47 The American Institute of Baking conducted a study in 1950 and re- ported, ".The addition of fluoride ion in concentrations up to 10 parts per million in the sponge and dough water has no effect upon bread quality. Bakers in communities that plan to incorporate fluorine in the city water supplies as part of a program to reduce the incidence of dental caries should anticipate no difficulties in using such water for bread production." 39 It is reported that Green Bay and Kaukauna, Wisconsin, have some of the largest cheese plants in the world. Green Bay's water supply con- tains 2.5 ppm fluorine and Kaukauna's water has 1.8 ppm fluorine. 44 It is also reported that Milwaukee breweries used deep well water con- taining as high as 1.8 ppm fluorine before the city began to use lake water. The following cities in Wisconsin have brewing industries and use water containing fluorides either in controlled amounts of about 1 ppm or incidentally occurring at 2 and 3 ppm: Rhinelander, Beaver Dam, Sheboygan, Columbus, Madison, Oshkosh, Green Bay, De Pere and Allonez. 44 The assertion: r. 41. The mere contemplation of vital statistics is an insufficient evalua- tion of the safety of fluorides, and group statistics tend to obscure the effects on individuals. The fact: It should be pointed out that group data are collected by examining individuals. The data from all individuals examined are pooled not to make the data applicable only for the group, but to obtain a higher degree of reliability as these apply to the individuals in the group. The most .crucial investigations of the physiological effects of fluorides have been made in areas where the water contains from three to eight times as much fluoride from natural sources as is recommended for dental health. Several hundred thousand individuals, including people of all ages and of varying states of health, make up these study groups. 18 tion, the A.M.A. secretary said in an editorial in Today's Health Maga- zine: "... the unscrupplous opponents of fluoridation have spread the impression that the American Medical Association did not endorse this public health measure (fluoridation). The fact is that it did, and that it stands by its endorsement. It is true that the endorsement did not urge any action whatsoever upon responsible officials because that is not the function of the Association. Both the A.M.A. Council on Phar- macy and Chemistry and the A.M.A. Council on Foods and Nutrition expressed themselves definitely to the effect that fluoridation is safe. If this is not an endorsement —what is it ?" 55 The assertion: 39. A congressional committee, headed by Rep. Delaney, has recom- mended a delay in the adoption of fluoridation because research on the procedure is not yet completed.38 The fact: An analysis of this report, published in the September 1952 Journal of the American Dental Association 40 pointed out that the report "suf- fers from a lack of adherence to the proper standards of investigative procedure as evidenced especially by its failure to substantiate many statements which it accepted as fact. The Committee also accepted mis- givings of a few individuals who appeared as witnesses, in spite of ,the weight of evidence furnished by such organizations as the American Dental Association, the American Medical Association, the U. S. Public Health Service, the National Research Council, the American Public Health Association and the Association of State and Territorial Health Officers." An editorial in the Journal pointed out that "The value of a scientific discovery ... cannot be determined by a show of hands among mem- bers of a congressional committee." The report does trot reflect the attitude of the Congress but is an expression of opinion of the seven men who were members of the Committee. Congress has acted, how. ever, in providing for the fluoridation of the public water supplies in the District of Columbia. The failure of the Committee to utilize evaluating procedures that would be acceptable to a scientific group is largely responsible for serious defects in its report, with the result that little credibility can be attached to the observations or recommendations contained in it. The assertion: 40. Fluoridation may interfere with food processing which involves yeast fermentation. 17 of very high concentrations of fluorides with the minute amounts in public water supplies in the ratio of one part per million. The assertion: 11. Fluoridation may aggravate the skin condition known as "acne." The fact: Because fluorine bears a close chemical relationship to bromine and iodine, there has been some fear expressed that fluorides would aggra- vate acne. This fear has been dissipated, however, by the results of tests reported by Dr. Ervin Epstein, assistant clinical professor of medi- cine in the division of dermatology of the Stanford University School of Medicine, San Francisco .2' Dr. Epstein has published results of tests conducted on 40 acne patients in which no difference was found in the rate of improvement between the patients who took prescribed fluoride tablets and those who did not. The assertion: 12. Fluorides are by- products of aluminum, a harmful material used for cooking utensils. The fact: It has long been demonstrated that the use of aluminum cooking uten- sils has no bearing on health. Moreover, fluoride compounds used for water fluoridation are not a by- product of aluminum plants. The Alu- minum Company of America does produce sodium fluoride, but in a, special plant, in the same manner as it is produced by others not in the aluminum industry.22, 50 The assertion: 13. Fluoridation should be put to a referendum for all people in the city to decide. The fact: No one will argue the right of citizens to have an opportunity to vote on any matter which requires such action. It has been traditional in America, however, to delegate certain responsibilities requiring techni- cal skill and professional knowledge to employed or elected representa= tives of the citizens. A very difficult and expensive program is required to inform all the people in a community regarding a highly scientific subject sufficiently to enable every person to vote intelligently. If, therefore, a city council is unwilling to assume the responsibility of making a decision on a technical subject and submits the issue to a referendum, a heavy respon. sibility involving a considerable amount of time and money is placed on civic and professional groups to provide for an adequate .public information program through which all citizens will be scientifically and accurately informed. The assertion: 14. Fluoridation is still in the experimental stage. The fact: Fluoridation of public. ,water. supplies cannot be considered "experi- mental" in the usual sense of the word that the procedure has not been adequately studied: Various factors relating to fluoridation' have been under. study for at .least 25 years.51 The most crucial investigations of the physiologic effects of fluorides have been made in areas where the water contains three to eight times as much fluoride as is being added in Grand Rapids, Mich., Newburgh, N. Y., and Brantford, Ont., in all three of which "experimental" pro- grams of fluoridation have now completed ten years: Several hundred thousand individuals, including people of all ages and of varying states of health, are included in the study groups from these areas. 54 Studies of the controlled addition of fluorides to water supplies, begun in- 1945, are demonstrating an identical. pattern of protection against dental caries for children born and reared in these communities as is observed in areas where fluorides occur incidentally in the water supply. Continued observations will establish the ultimate degree of effectiveness in older age groups in the controlled studies who used fluoridated water during childhood. As with all public health measures, fluoridation is subject to continued study, and research possibilities will never be exhausted: As time goes on, finer details will become known that may, even more" greatly en- hance the value of fluoridation, but studies and experience have passed the stage where there is any reasonable doubt as to its safety or effec- tiveness. ;The '.assertion: 15: Fluoridation benefits children only. The fact: It is true that in 'the beginning of a fluoridation program, the greatest benefits will accrue to the younger children; however, as these children become adults, they will continue to benefit and eventually the entire continuous-'resident population of the community will be enjoying ;the full benefits from fluoridation. Studies conducted among adults in fluoride areas show that the dental benefits continue throughout life.28 7 ine as a result of a process, involving water with a concentration of 1 ppm fluorine; yet,-this fact should cause no concern.-Other common foods contain, as high as 60 ppm fluorine naturally." However, such items are not expected to increase a person's overall consumption of fluorides because they are eaten in relatively small quantities as compared with the quantities of water consumed daily. The assertion: 37. The vital statistics of Grand Rapids, Mich. show an increased num- ber of deaths from heart disease, intracranial lesions and nephri- tis since the program of fluoridation was initiated. The fact:. - . . This . statement presents an erroneous, implication because it is based on a comparison of 1944 data for the city of Grand Rapids with 1948 data for the whole of Kent County in which Grand Rapids is 'situated. Reliable population data for this area are available from official agen- cies in Grand Rapids and in the'state of Michigan and are based on an intimate knowledge of shifts of population in and out of the city. Actually, changes in the death rates in Grand .Rapids have not been significantly different_from.those for the country as a;whole. A claimed increase in the number of deaths from heart disease in 1949 is not a fact but is due to a 1949 revision in the method of recording deaths. 41 The assertion: 38.• The American' Medical Association did not give. an unqualified endorsement of fluoridation of drinking water. , The fact: A resolution of the House of Delegates of the American Medical Associa- tiori at its meeting in Dec: 1951 endorsed the fluoridation of water sup- plies. The A.Nf.A. secretary stated that the House of Delegates did not "urge" adoption of the dental measure and explained that "it' was the opinion of the Council (on Pharmacy and Chemistry) that this question (of recommendation for or againsi) "should be answered by the dental profession." The A.M.A. statement of policy concludes that "Fluorida- tion of water supplies in a concentration not exceeding one part per million is nontoxic and-its principle is endorsed." 37, 2 The American Medical Association also, approved a. statement of, the Intel- Association Committee on Health, of which it is a member, which reads: "Resolved, that'the Inter - Association Committee on Health urges the fluoridation of the fluoride - deficient public water supplies of this country as rapidly as plans can be approved by the local medical, dental And health department officials and the state departments of health." al In 1955, four years after the original A.M.A. endorsement of fluorida- 16 of fluoridation, were taken only after critical evaluation of research data. The evaluation was made by councils composed of many of the nation's outstanding medical and dental scientists. 40 The assertion: 35. No one is sure that fluorine is the element responsible for lower dental decay rates or that "inorganic or nonionic" fluorides, when added, will have the same effect as those that occur "naturally" in the water supply. The fact: Studies have been made of the relationship between dental caries rates and various properties of public water supplies, including hardness and various chemical constituents; yet animal studies, controlled fluor- idation studies and studies in areas where fluorides occur incidentally in water demonstrate that fluorine is the one element consistently assoc- iated with the observed dental caries reductions. The analytical method which has been employed to measure the fluor- ine concentration in water is one which measures the concentration of available fluoride ion. The physiological effects of "natural" fluoride - bearing water are related to a fluoride ion, and it is also a fluoride ion which will be present in the water as a result of the addition of the compounds employed for controlled fluoridation. Whether there also is fluorine in nonionic form or organic combination has no logical bearing on the consideration of the fluoridation procedures.40.61 The assertion: 36. The Federal Food and Drug Administration might take action against processors of foods prepared with fluoridated water. The fact: This implication is not correct, as shown by the following statement issued in the Federal Register of July 23, 1952: "The Federal Security Agency will regard water supplies containing fluorine, within the limitations recommended by the Public Health Serv- ice, as not actionable under the Federal Food, Drug and Cosmetic Act. Similarly, commercially prepared foods within the jurisdiction of the Act, in which a fluoridated water supply has been used in the processing operation, will not be regarded as actionable under the Federal law be- cause of the fluorine content of the water so used, unless the process involves a significant concentration of fluorine from the water. In the latter instance the facts with respect to the particular case will be con- trolling." Such foods as corn syrup might contain several parts per million fluor - 15 The assertion: 16. Artificial fluoridation may not produce the same results as do natural fluorides. The fact: Actually, there is no such thing as "Artificial fluoridation." Fluorides are always added to water, generally being picked up by the water running through underground passages and crevices where the ground contains various fluoride compounds. In this process, man has no con- trol over the concentration. Studies show that the same results occur whether the fluoride is added in controlled amounts by man or added accidentally by nature, except that dental benefits are assured and no tooth staining occurs when the fluoride is added in controlled amounts. The assertion: 17. One could just as well add fluoride to table salt, milk, bread or some other foodstuff. The fact: Fluoride is a natural constituent of many water supplies. The discovery that fluoride ingested in proper amounts reduced tooth decay was the result of work in towns where the supplies contained fluorides naturally. Water, therefore, is a natural medium for caries control. It is impractical to add fluoride to table salt because it is not uniformly consumed and because the use of salt with a common fluoride content would be hazardous in view of the widely varying natural fluoride con- tent of water supplies. The consumption of food items, such as milk and bread, varies considerably among individuals; however, the intake of water, though it may be irregular, is less variable than any other single item in human nutrition. There are also practical difficulties that would hamper the "fluorida- tion" of such items as milk, bread and salt. For example, control test- ing would be difficult and responsibility for the procedure would be divided .29, 30, 4.1 Fluoridation of the public water supply is especially practical and safe because it is constantly subject to control by competent health authori- ties and does not require action on the part of individual citizens.al The assertion: 18. Costs are going up all the time, and the city cannot afford to add another item to its budget. The fact: This statement might more correctly be put, "The citizens can hardly afford the. luxury of going without fluoridated water." Experience in more than 1,100 (January 1956) communities . in the United States has demonstrated that fluoridation is an inexpensive procedure. The cost varies in different cities but averages less than 94 per year per person, often less than the cost of a candy bar. Fluoridation will reduce future dental bills for fillings, extractions and replacements. The cost of. an average filling will pay for fluoride for one person for about 30 years. 26, 27, 87 .The assertion: 19. It is wasteful to fluoridate all the water when only a small amount of it is used for drinking purposes. The fact: w Treated water, treatment including chlorination, softening and other processes, is used also for watering lawns, washing cars and for most industrial purposes, yet it has been found much more practical to treat the entire water supply than to have separate water systems. The same is true of water fluoridation, particularly in view of the fact that the annual cost per person will average about 94, and this amount covers fluoridation of all the water, not just that used for drinking purposes. The assertion: 20. Fluoridation_ has not been "recommended" by the American Water Works Association. The fact: The water works engineer is not in a technical position to recommend fluoridation. Such recommendations are the prerogative of the dental, medical and public health groups. The American Water Works Associa- tion has stated, however, that the water works industry is willing and ready to follow through when the proper authorities recommend or approve the treatment.30 The assertion: 21. Fluoridation is a restriction of religious freedom. The fact: Some people assert that the free exercise of religion is interfered with by the fluoridation of community water supplies. This contention is based on the supposition that the addition of fluoride to water converts the water into a medication. Even if fluoridation could be considered medication, precedents in the interpretation of the freedom of religion clause of the First Amendment to the Constitution of the United States The assertion: 32. The city water works company will be held liable for suit if some- one claims he is harmed by fluoridation. The fact: The opinion of the Attorney General of Michigan (1944) on this sub- ject seems to be typical of the judicial opinion in most states regarding the liability of the owner of a public water supply: "A water supply corporation is ... bound to use reasonable care and diligence in pro- ducing pure and wholesome water that is at all times free from any in- fection or contamination which renders the water unsafe and dangerous to individuals, or unsuitable for domestic purposes, and is liable for injury resulting from its failure to do so." 2a "The same rule is generally held applicable to municipal corporations. Before liability could be established, it would .be necessary that the plaintiff show negligence on the part of the utility or municipality furnishing the water and show that his injuries resulted from such negligence." 86 The assertion: 33. Fluoridation will adversely affect the manufacture of ice. The fact: The only problem reported in industry to date was at Charlotte, N. C., where cracking of artificial ice was attributed to fluoridation. The local water supply is soft and has a low alkalinity. By using methods avail- able to the ice industry, the problem was entirely eliminated. Artificial ice plants in other cities have not experienced similar difficulties. 80 The assertion: 34. Many of the groups who endorse fluoridation merely are parroting each other's opinions. They have done no original research work themselves. The fact: This statement is entirely misleading since many of the members of the organizations' noted have participated directly in experimental studies, population surveys and other investigations which have 'demonstrated the safety and effectiveness of fluoridation. Consequently, the conclu- sions of these agencies reflect the expert knowledge of their individual members who have taken part in the original work relating to this pro- cedure. The official actions of the American Dental Association and the Amer- ican Medical Association, with respect to the safety and effectiveness 14 The assertion: 29. Fluorides block rather than aid calcification when magnesium is . low 'in the water supply. The fact: . According to Dr. A. E. Sobel, there is no justification for concern about a detrimental effect of lack of magnesium on the caries- preventive effect of fluoridation. This opinion is in agreement with a statement made by a U. S. Public Health Service researcher. Dr. Sobel's test tube findings have not been duplicated in animal or human experience and provide no evidence that magnesium has any influence on the beneficial effect of fluorides. 32 The assertion: 30. Fluoridation will present many difficult engineering problems. The fact: Water works operators have found through experience in more than 1,100 communities (January 1956) that the addition of fluorides to a municipal water supply is practical from an engineering standpoint. The mechanics of fluoridation are no more involved than those of water purification; moreover, the machinery and equipment commonly used in water plants are easily adapted.1e, 28 The community's desire for fluoridation may be used as a lever to. get other needed improvements made in the water plant, but the installation of a fluoridation program should not be made dependent on incidental improvements not required for effective fluoridation. The assertion: 31. Adding fluorides to water may present a hazard to workers in the water plants. The fact: Considerable attention has been given to the possible hazard to plant operators handling fluoride compounds and inhaling fluoride dust. To counteract this potential danger, proper precautions are taken by pro- viding operators with masks and gloves to use when filling the fluoride feeders and by providing exhaust systems in the larger plants. Water plant . operators state that no serious operating problems are encoun- tered in the plant and that under proper precautions, fluoridation ap- pears to be no more hazardous to the operating personnel than is chlorination. 16,24 The superintendent of the water department at Evanston, Ill., states, "Application of sodium fluoride at Evanston has caused less maintenance and operating difficulty than any other water works chemical." 86 demonstrate that the right of a special group to engage in the practice of its religion must not unreasonably interfere with the right of a community as a whole to enjoy, what it determines is beneficial for its well- being. The National Institute of Municipal Law Officers has expressed the opinion that fluoridation does not violate constitutional rights of free- dom of religion.42 This opinion has been upheld in recent legislation directly concerned with fluoridation. The constitutionality of the fluori- dation program has been upheld in several legal actions, among others: De Aryan vs. City of San Diego, 280 P.2, 98 and Kraus vs. City of Cleveland. The assertion: 22. The fluoridation experiment does not adhere to the .10 standards set up by the Nuremberg War Crimes Tribunal for experimentation on the lives of human beings. The fact: 21. About this erroneous idea Dr. Leo Alexander, Boston physician and a medical adviser to.the Nuremberg Tribunal commission, wrote as follows: "In my opinion the dragging of our well thought out prin- ciples on human experimentation into the problem of fluoridation of water is a scurrilous bit of sophistry based on the distortion of the main fact, namely, that such a public health measure could possibly be con - strued to be human experimentation in the sense of those experiments to which our principles are to be applied. i "It seems to me that the basic part of the work on fluoridation that could be construed as experimentation had actually been done long ago by nature itself. From the literature submitted, it appears that a great many. competent investigators have proven the fact that fluorine con- centration of drinking water between 1.2 -3 ppm, occurring .naturally in many localities, is perfectly innocuous. Since then, the proposed fluor- idation of water can no longer be regarded as an experiment in the sense of our ten rules." 43 The assertion: 23. The fluoridation of public water supplies 'constitutes mass medi- cation. The fact: The generally accepted definition of medication as used by dentists and physicians refers to the administration of remedies tiy treat or cure a given condition. 23 Fluoridation does note constitute,�a remedy; it does not treat an existing disease. Fluoridation, supplies. ;a normal constitu 13 10 ent found in human teeth and makes. fluorine. available in the proper amounts through a natural source for the development of decay- resist- ant teeth. Fluoride, like calcium and phosphorus, is a natural constituent of teeth .and bones and must be supplied to the body. through food or drink in order to produce normal calcified structures. Fluorides in the public water supply are no more a medication than are other substances normally found in water .or than the various constituents, of food nec- essary for the maintenance of health. Adding sodium fluoride to the water supply is no more a medication than adding table salt or other materials to food to make it palatable and healthful, or adding chlorine to the public water supply for the. prevention of intestinal diseases. The - addition of certain chemicals to white flour to enrich it is now required by law in some 27 states as a nutritional measure. The assertion: 24. Fluoridation constitutes socialized medicine. The fact: As is pointed out in the preceding section, fluoridation is not medics-, tion or a form of "medicine.'.' Fluoridation is no more "socialized" than is chlorination or other measures employed by the community for the prevention of disease. In fact, fluoridation represents one of the most realistic arguments against "socialized medicine" inasmuch as it is,a preventive measure and is a project which communities determine and provide for themselves. The assertion: 25. Fluoridation is compulsory medication.in that everyone is compelled to drink the fluoridated water. The fact: . Again, referring to preceding sections of this report, fluoridation is not medication. Fluoridation does not mean compulsion on the part of in- dividuals any more than does the use of other community resources, in- cluded chlorinated water. People form .communities so that they can share such common public services as schools, fire departments, water supplies and libraries. If a separate group in the community wants a school that is different from -that chosen by the majority, then it es- " tablishes its own. The same principle applies equally to the water and. ri milk supplies. If a community wants its water fluoridated and its milk pasteurized, then fluoride -free water and unpasteurized .milk can be obtained outside the community. It may be pointed out in addition that .it would. he a travestry of the 11 democratic process of free choice if a minority of misguided but militant partisans were to.be permitted to prevent the majority of the population from choosing to obtain relief from dental disease by the simplest, cheap- est and most effective method available. The assertion: 26. An accident in the water plant might cause over - dosage and severe harmful effects. The fact: Acute morbidity manifested by increased salivation and vomiting may be caused by ingesting 0.25 g. sodium fluoride. This quantity in an 8 -oz. glass of water represents 1,000 ppm sodium fluoride, or about 450 ppm fluorine. To obtain this concentration, it would require more than four tons of sodium fluoride per million gals. of .water processed which is obviously not possible in a program of water fluoridation, even if gross negligence occurred. 29 The assertion: 27. Through ' just one. twist of a valve,. an enemy could flood the city with poisonous, fluorides and kill off the whole' population. The fact: This statement has appeared in several newspapers. See answer to pre- vious statement. It seems hardly likely that saboteurs would attempt to rely on tons of sodium fluoride when one ounce of botulinus toxin in a reservoir of water would have much greater eflect. The assertion: 28. There may be, individual variations in the .amount of water con- sumed dailyand in the reaction of different individuals to.fluorides. The fact: Individual variations are no greater in areas where the water contains controlled amounts of fluorine than where there is naturally 1 ppm fluorine in the water supply. Variations in total amount of water con- sumed are not as great as sometimes presumed. In such communities there is no mottled enamel visible to a lay person; and it has 'been: de- monstrated that there are no harmful eflects;'yet these communities, too, have people who vary in their water intake and in their physiological reaction to all substances. 's The .optimum ' level has been established after extensive experience with its effect on humans. 12 Water Fluoridation Report of the Committee of the St. Louis Medical Society Reprinted from pages 124 to 142 of the February, 1954, MISSOURI MEDICINE Copyright, 1954, by Missouri State Medical Association Water Fluoridation Report of the Committee of the St. Louis Medical. Society Summary 1. Fluorine is an element existing widely in food and water, varying in its concentration in the latter from traces to excessive amount. The fluoridation of a communal water supply entails only supplementing a deficient natural concentration. There is no way of proving by chemical test that the element, fluorine, exists in the same chemical combination in its natural concentration as results from its addition in whatever salt of fluorine is chosen. From chemical theory, how- ever, and from all observed facts of its behavior, the inference is plain that the soluble fluoride ions are equally effective at a given concentration, however introduced. 2. There is an inverse relationship between the concentration of fluoride ion in the water supply, whether naturally occurring or the result of the sup- plement, and the incidence of dental caries. This has been proven by observation of inhabitants of many communities and is accepted widely by those who op- pose fluoridation for reasons other than its effective- ness. The proper amount to be added as supplement for a given community is arrived at in recognition of the experience of dental caries in the school children, the naturally occurring concentration of fluoride ion in the water and the climatic conditions peculiar to that locality which influence the intake of water. The benefit to be expected can best be stated by members of the dental profession and local public health of- ficials, and will be in proportion to the prefluoridation caries experience of that community. While fluorida- tion importantly reduces the incidence of caries, it does not completely eliminate it and does not diminish the need for adequate diet, mouth hygiene and dental inspection at proper intervals. While fluoridation be- gins to show its effects in a year or two in school children, the maximum benefit is seen in those per- sons using fluoridated water from birth. The increased resistance to caries extends at least into middle life, hence it is incorrect to assert that only children are benefited by such a program. 3. At the levels of intake supplied in fluoridation programs, there is practically no storage of fluorine except in the teeth. The ideal daily amount is about one milligram in temperate or predominately cool climates and would be obtained by drinking one quart of water containing 1 part per million of fluoride ion. Storage elsewhere in the body has not been demonstrated with daily intakes of as much as three or four times that amount. Storage in bone apparently occurs with daily intakes substantially above 4 mg., though without demonstrable ill effect on persons who have lived all their lives with a water supply containing 8 parts per million of fluoride. A wide margin of safety is thus provided, inasmuch as intakes of fluorine about fifty per cent above the ideal dose produce very mild evidences in the appearance of the teeth of such excess. These dental warnings are detectable only by expert examination and are in no way harmful to the teeth. There is no published rec- ord of any injury to the health of any person drink- ing natural fluoridated water with a concentration as high as 8 parts per million, nor of harmful effects at such lesser concentrations as occur naturally or are provided in fluoridation programs. No injurious ef- fects can be found in the study of vital statistics of all the common major diseases, including cancer, or in the statistics of maternal and newborn death rates. Experimental studies on man (the most sensitive species) and lower animals confirm these evidences of the safety of a fluoridation program. Physicians practicing in areas which have had fluoridation .pro- grams for three years or more report that their ex- perience in the treatment of the sick does not differ from their pre- fluoridation practice and that they do not forbid the use of fluoridated water in any case. 4. The public health and water engineering prac- tices are relatively simple. They include selection of the most desirable compound of fluorine to be used, provision for safety measures for handlers of such chemicals, installation of feeding equipment and reg- ular performance of chemical tests at various points in the distributing system in order to regulate the desired concentration. Annual cost in most commu- nities has varied between nine and fourteen cents per capita. 5. An impressive roster of persons and organizations of recognized scientific standing has endorsed the ef- ficacy and safety of fluoridation. Over 3,000,000 per- sons live in areas whose natural water supplies con- tain from 0:9 to 5 parts per million of fluorine. Tes- timony has been furnished from the physicians of twelve communities with a combined population of nearly 800,000 persons who had fluoridation programs for from three to seven years as of January 1, 1953. As of August 1, 1953, 772 communities in 43 states, including 10 major cities, have fluoridation programs serving a total population of 14,000,000 persons. In the United States, such widespread adoption of any program of preventive medicine, determined upon at the local level has profound significance as to the solid merit of the proposal. 6. Testimony in opposition to fluoridation has been expressed by a numerically tiny minority of persons of undoubted scientific training and experience in relevant fields. Close examination of their testimony reveals that they do not usually question the effective- ness of the procedure but have reservations as to possible toxic effects. They do not lay down criteria by which they would judge a fluoridation program to be any safer than it has already been shown to be. In requiring an indefinite prolongation of presently established programs before extension to other areas they tend to disregard what has already been learned. There is also an active, proselyting opposition that does not represent an objective, scientific point of view at all. It seeks to defeat proposals for fluoridation by the circulation of pamphlets containing obsolete or discredited or irrelevant charges ranging from "Operation Rat Poison" to "communistic plot" themes, with a measure of food faddism for good measure. There is no authoritative expression of opposition from any religious sect nor from the representatives of any school of healing the sick which is recognized by law in Missouri. WATER FLUORIDATION 7. There are no practicable alternatives to fluorida- tion of water in a city such as St. Louis. The provi- sion of fluorine intake through tablets, milk, salt or other means has profound disadvantages peculiar to each one. Topical fluoride application directly to the teeth by skilled personnel cannot be applied univer- sally as a public health measure for the prevention of dental caries, insofar as it is effective, due to lack of personnel and funds. While somewhat less effective than fluoridation of the water supply, it has merit as an alternative public health measure in small com- munities without such a common source of water. 8. The use of water containing the recommended concentration of fluorine has been shown to be with- out hazard in the industrial use of water. There is testimony to this effect by research chemists of the associations of brewers, bakers and bottlers as well as by use of naturally fluoridated waters in earlier times without dissatisfaction. Such fears as have oc- casionally been expressed have not been documented and appear to be contrary to observed fact. There has been no recorded, open opposition to this measure of preventive medicine from any industry, nor is any to be anticipated in the future. 9. The power of a municipality, acting through its elected representatives, to initiate fluoridation of its water supply by legislative action has been upheld wherever challenged in court. Such a procedure is held to be proper exercise of police power of a com- munity to conserve or improve the health of its res- idents. A fluoridation program does not treat caries already present. It is effective in increasing the resist- ance of the developing tooth to the occurrence of caries. "Preventive Medicine" is an obviously more accurate description of its purpose and effect than is "Mass Medication," usually introduced acrimo- niously. 10. No other public health measure has had more thorough study prior to adoption than the proposal for fluoridation of the community water supply whose natural concentration of fluorine is deficient. The ideal concentration of fluoride ion to be delivered at the outlets should be decided by the responsible pub- lic officials after study of current information, partic- ularly of climatic effects, and after such consultation with other authorities as they deem necessary. Con- tinued studies and periodic reporting of the caries experience of selected groups of children, as done at present in St. Louis, together with careful scrutiny for incipient signs of dental effects of excessive flu- orine ingestion should be carried out as an essential feature of such a program. Recommendation The members of the Water Fluoridation Committee of the St. Louis Medical Society unanimously recom- mend that the elected officials of the City of St. Louis undertake without delay the necessary legislative and administrative steps to authorize and initiate a pro- gram to increase the content of fluorine of the munic- ipal water supply to an amount whose concentration will provide maximum reduction in the incidence of dental caries of the children of St. Louis commen- surate with freedom from objectionable cosmetic ef- fects or hazard to health of the residents as a whole. This recommendation is made in the conviction that such a step will constitute the most significant contribution to the public -health of the community 2 since the enactment and implementation of the Smoke Abatement Ordinance. (Signed) HAROLD A. BULGER, M.D. RAYMOND O. MUETHER, M.D. WILLARD BARTLETT, M.D., Chairman August 24, 1953 Study The pathways by which the human body absorbs the fluoride ion in ideal dosage and rids itself of all but a small fraction are well understood. It is essential that one comprehend these mechanisms for with such knowledge as a foundation, the facts and fallacies in- volved in programs for the fluoridation of a water supply lose much of their mystery for the lay student. Definition of the "ideal" daily dose is the first step. In medical terms, it is the physiologic dose. As with many other substances having valuable properties when administered in a properly prescribed daily amount, fluorine becomes a harmful, rather than a beneficial agent when given in excessive, or toxic, quantities. This is equally true of iodine, bromine and chlorine, the other members of the family of chemical substances known as the halogens. They are widely distributed in animal and plant life and most natural- ly occurring waters contain them in varying con- centrations. In physiologic concentration, for example, chlorine combines with sodium to form the largest portion of the salts in solution in the blood itself. In a different combination and concentration, it exists as the hydrochloric acid which is the principal chem- ical agent in digestion of food in the stomach; it is administered by mouth throughout a life time to pa- tients whose own digestive juices are deficient. In still other concentrations and chemical combinations chlorine is used to prevent the growth of harmful germs in water supplies and, in murderous form, it is the principle component of war gas. Common table salt is the same chemical substance as the sodium chloride in solution in the blood and tissue juices, yet excessive intake of salt, or no intake of salt, pro- duces grave illnesses; the same statement is true of excessive or inadequate intake of water alone, , yet water makes up about 70 per cent of the weight of the human body. In considering the effects upon the human body of a given element, therefore, one must define not only the chemical compound itself, but the concentration in which it is to be delivered, the total daily dose and' the period of time over which it is to be administered. For the fluoride ion the ideal, or physiologic, dosage is approximately 1 milligram (mg.) per day which is achieved by the human utilization of drinking water and water used for cooking from a source containing an average concentration of 1 part of fluoride ion per million parts of water (1 ppm). This intake of fluoride is calculated as a proper addition to the small amount contained in various solid foods. The needs of the body for water are fixed by nature and, although habitual intakes of drinking water, or of substances dissolved in water, vary widely with the individual, the differences are not significant in alter- ing importantly the effects upon the human body of these small quantities of fluorine. Since few naturally occurring waters are completely free of fluorine, one should always think of a fluoridation program, not as addition of a substance foreign to the water, but as a WATER FLUORIDATION process of supplementing an inadequate concentration. In many communities in the Southwestern States pro- grams of defluoridation have been instituted in order to remove an undesirable excess of fluorine and to lower its concentration, not to zero, but to physiologic levels. It must be understood, moreover, that it makes no demonstrable difference to the human body whether the ideal concentration of fluoride in its water supply has been achieved naturally, by supplement or by defluoridation. Whatever chemical combination of fluorine, the element, is dissolved in water as flu- oride ion and is measurable by standard tests is capable of absorption by the body.'•' 04 Fluorine is properly considered to be one of the "trace" elements normally present in very small amounts in the human body. Its usefulness in in- creasing the resistance of the teeth to decay (dental caries) has only become obvious in recent years and will be elaborated subsequently. In physiologic dos- age, very small amounts of fluoride are stored in the enamel of the teeth of infants and children before hardening of the enamel is completed and particularly before the permanent teeth have erupted into the mouth. In physiologic dosage, storage of fluoride ion elsewhere in the body has not been demonstrated. The remainder is passed (excreted) from the body in the urine, sweat and feces.'•',' There is, as yet, no other known beneficial role which such small quantities of fluorine play in the human economy. The ideal, or physiologic, dosage of fluorine is therefore that amount, in the concentration and quantity already described, which will importantly reduce the incidence of dental caries and which will not produce undesir- able effects. In temperate climates the year -round ideal concentration in a water supply has previously been stated to be 1 ppm. The permissible upper limit has been set as 1.5 ppm," for with even moderately higher concentrations of fluorine no considerable added protection against dental caries is seen' and an undesirable cosmetic phenomena fluorosis (notice- able brownish mottling of the enamel), begins to appear in a small percentage of people. No document- ed instance of damage to health has been recorded from the use of water containing the physiologic dos- age of fluorine, whether naturally occurring or sup- plemented, no matter over how long a period.`',' It has already been stated that variations in the total daily intake of properly fluoridated water do not produce "important" alterations in physiologic effects. This needs qualification, for seasonal concentrations should be related to the ideal, year -round concentra- tion of 0.9 to 1.5 ppm of fluoride ion for a temperate climate. Climate plays a part in determining the total fluid intake of the population. It is important to re- member that about 90 per cent of the weight of a solid, general diet lies in its water content and added liquid is drunk to make up the body's need for total daily water intake; water is made available by the body for the formation of urine only after all the other needs for water, including the formation of sweat, has been met. In warm, humid periods of the year the need for water is increased and it has there- fore been the logical practice in communities with a fluoridation program to reduce the amount of fluoride added to the water supply in order to produce a con- centration at the outlets of as little as 0.6 ppm under such climatic conditions, raising the latter to 1 ppm or slightly higher during cool weather " Allusion has been made to the fact that with in- 3 creasing concentrations of fluoride ion cosmetically undesirable mottling of the enamel appears in increas- ing percentages of children who have been on such an intake from infancy. This is noticeable to the un- trained observer and persists throughout the lifetime of the individual; no harm to the structure of the tooth is involved. Such grossly noticeable mottling does not occur with ideal concentrations which are appropriately adjusted downward in spells of hot weather. Under these circumstances, less than 15 per cent of children at ages 12 to 14 years develop a very faint change in color of the enamel, localized on various surfaces of the teeth and detectable only to the trained observer using instruments and special illumination.' There is, therefore, no cosmetic hazard with physiologic conditions of fluoridation, natural or planned. The warning sign that the ideal daily intake is be- ing exceeded lies precisely in the appearance of dental fluorosis, mottling of the enamel, as concentrations of fluoride ion in the water supply are increased. The large margin of safety is apparent when one reviews the incontrovertible evidence that water containing 8 ppm has been the only source of sup- ply for the community of Bartlett, Texas, during several generations without detectable evidence of in- jury to health upon searching scrutiny of the popula- tion." Aside from mottling of the teeth, increased bone density in x -ray examination in 11 per cent of the persons examined was the only deleterious effect found; it was not associated with symptoms and con- stituted the only way except for dental effects in which these people were found to differ from the inhabitants of a neighboring community with in- adequate amounts of fluorine in the water supply. Completely reliable data" reveal that water naturally containing 1.0 to 1.5 ppm is used by more than one million people. Water containing 1.6 to 2 ppm is used by more than 900,000 persons. Water containing 2.1 to 3 ppm is used by more than 600,000 persons. Water containing 3.1 to 5 ppm is used by more than 100,000 persons. Water containing more than 5.1 ppm is used by 40,000 persons. A total of 3,000,000 persons in the United States, then, have for many years been using water naturally containing fluoride ion in concentra- tions, variously, between 0.9 and 5 ppm and in none of them has an authentic case of injury to health at- tributable to the fluorine concentration been reported in the vast medical literature. The reasons why none is to be anticipated, even at these concentrations of as much as five times the ideal daily dosage, will be elaborated. Before proceeding to comment on the published studies that have - demonstrated the absence of a haz- ard to health in the use of water containing fluorine in concentrations even higher than the ideal, let us recapitulate briefly the observed facts presented hither- to for consideration: 1. The discussion of the effects upon health of any waterborn element must define a) the chemical com- bination in which it is to be employed, b) the total daily dosage, c) the concentration to which it will be diluted upon delivery at the tap, and d) the period over which it is to be consumed. 2. The ideal, or physiologic, daily dose of any sub- stance is that amount which will produce the desired beneficial effect in a reasonable percentage of in- stances without doing harm. 3. The physiologic dose of the fluoride ion, judged WATER FLUORIDATION from the point of view of its dental effects, is ap- proximately 1 milligram daily. This is attained in temperate climates by drinking water which has naturally a concentration of about 1 part per million of fluoride or to which fluorine has been added to approximate that concentration in communities where the water supply contains less than the ideal amount. 4. In physiologic dosage, fluorine is not stored in the body except for that very small amount that enters into the process of hardening the enamel of the developing teeth. The remainder is lost to the body, principally in the urine. 5. No evidence of injury to the well -being of any person, sick or well, infant or aged, has been related to fluorine present in water in physiologic concentra- tion. 6. The teeth of persons receiving water containing physiologic concentrations of fluoride, properly ad- justed to local climatic conditions, do not show dis- coloration. 7. At concentrations of fluoride rising above 1.5 ppm visible mottling of the teeth is observed with increasing frequency. This is undesirable from the cosmetic viewpoint. 8. The appearance of mottling detectable only by a trained observer in more than 10 per cent of chil- dren is an indictation that physiologic doses are being exceeded. 9. The margin of safety with concentrations of flu- oride higher than ideal is so wide, that no sign of ill effects has been detectable by close scrutiny even of the members of one community using a water sup- ply containing 8 ppm for several generations. Over 3 million persons in the United States live in com- munities where the natural concentration of fluoride in the respective water supplies is, variously, from 0.9 to 5 ppm. There is no medical record to show that, aside from relative freedom from dental caries, their health differs from that of persons dependent upon water containing less than ideal amounts of fluorine. 10. No distinction is to be made between the effects on the human body of fluoride ion naturally occur- ring in a water supply and the same concentration of fluoride attained by either supplementation or deflu- oridation. It is not surprising that relatively few organized investigations of the health of persons living in com- munities whose water supplies have a physiologic concentration of fluorine, either naturally or by sup- plement, have appeared in the medical literature. Such inquiries into the possibly toxic effects of any substance in the natural water supply employed by a population are prompted either by 1) reports of damage to health in individual cases or 2) the pub- lication of reports of laboratory studies on animals and human volunteers indicating that the behavior of the substance in the body under applicable conditions is such as to make it likely that evidence of injury to health in specific ways may appear and should be sought. In the total absence of such clinical or lab- oratory reports of health hazards with respect to ideally fluoridated water, few community health de- partments have found themselves so plentifully sup- plied with the taxpayer's money that they could divert funds and personnel to looking for trouble where none was to be anticipated. Such an effort is a luxury, comparatively, in view of the urgent needs and limited sums with which all departments of health and sanitation are chronically faced. The con- scientious and highly trained members of federal, state and local public health professional associations study critically the investigations in their field and do not lightly or carelessly endorse proposals for preventive measures whose conceivable harm might outweigh the benefits. As will be brought out, there is a still larger body of published evidence as to the safety of drinking water containing higher than physiologic concentrations of fluoride and this has been the logical field for the most intensive study of the problem. Let us examine, then, the reports which bear on the safety to the consumer of drinking water containing fluoride ion in concentrations of up to ap- proximately 5 parts per million. The city of Newburgh, N. Y., was one of the first communities in this country to add fluorine (as sodium fluoride) to its natural water supply (1945) bringing up the concentration from 0.1 ppm to 1 ppm. Systematic continuing examinations of school children have been reported in respect to general physical examination, analyses of blood and urine, x -rays of the bones of the hands, forearms and legs and special eye and ear examinations in selected samples; detailed dental records have also been kept for comparison with the pre- fluoridation data obtained in Newburgh and in neighboring Kingston, N. Y., which, had a similarly meager concentration of fluorine and from which fluorine supplement has been withheld for the .sake of comparison. These studies have 'been carried out in conjunction with the New York State Depart- ment of Public Health. As reported in 1950" and again in 1952, we read: "Careful examinations carried on since the study started reveal absolutely no harm- ful effects from drinking fluoridated water. "" Herman E. Hilliboe, M.D., Commissioner, New York State De- partment of Health, adds "These results bear out stud- ies made in other areas of the country, where persons have been drinking naturally fluoridated water all of their lives with utmost safety. "" No differences (other than dental) in the physical condition of the children of Newburgh and Kingston have been found; the dental benefits will be reviewed separately. The Evanston (Illinois) Dental Caries Study Group has also carried on regular examination of the school children since that community began to supplement (to 1 ppm) the negligible quantities of fluorine in its water supply in 1947. In a letter "' dated March 9, 1953, Winston H. Tucker, M.D., Commissioner of Health of Evanston, writes: "No detrimental effects of any sort have been found in the children on careful examina- tion. I am not aware of any evidence published in medical literature showing that there is an increase of any disease which could be attributed to fluorine in a concentration of one part per million in a pub- lic drinking water supply." Studies on a somewhat older age group have been made by McClure (then Senior Biochemist, National Institute of Health, Bethesda, Md.). He has reported" observations of height and weight and the incidence of bone fractures in 1458 high school boys residing in communities whose water supplies varied from zero to 1.0 ppm fluorine content. There is no correlation of the fluorine content of the water with growth and development or with the experiences of fractures of bones, as is evident in Tables I and II. The examination of vital statistics for any com- munity is a standard method of finding clues as to the possible relationship between a given disease and a suspected agent, causative, contributory or com- WATER FLUORIDATION plicating. From a series of published data, ", 19, 29, w. -n Table III has been prepared. It demonstrates beyond dispute the lack of any regular pattern of relationship between death rates from all cancers and the fluoride content of the water (varying from zero to 4.5 ppm) in several communities. In Table IV is evident the same lack of correlation between the periods of surviv- al of sufferers from several types of cancer and the flu- oride content of the water in San Francisco, which had little or no fluorine, and in Denver, which has 17, 19 1.2 ppm. Tables V and VI' reveal the relationship of deaths of pregnant women and of babies before and after birth to the fluorine content of the water in several TABLE I Comparison of the height and weight of 1458 high school boys, ages 15 to 17 years residing in cities with different concentrations of fluoride in public water supplies. Source (16). Fluoride Height Weight ppm Galesburg) Monmouth) Ill . ..............1.8 67.2 135.6 Aurora, Ill . ..................1.2 66.7 136.5 Elgin, III . ....................0.5 68.0 136.1 Quincy, III . ..................0.1 67.2 134.2 Waukegan, Ill . ...............0.0 67.4 135.8 Washington, D. C. ..........0.0 68.4 140.0 TABLE II Comparison of bone - fracture experience of 1458 high school boys ages 15 to 17 years, residing in cities with dif- ferent concentrations of fluoride in public water supplies. Source (16). Total number of Fluorine (ppm) bone fractures in water per 100 boys Galesburg .................1.9 27.0 Monmouth .................1.7 31.0 Aurora ....................1.2 25.3 Elgin ......................0.5 24.3 Quincy ....................0.1 21.3 Waukegan .................0.0 25.0 Washington, D. C. ........0.0 32.4 TABLE III Comparison of cancer mortality rate per 100,000 in areas with different concentrations of fluoride in the public water supplies. Source (19), (17), (18). (20) and (21). Texas Mortality Rate Cities having little or no fluoride (1948 -49) ........91 Denver Nacogdoches ) 1.2 ppm Tyler ) Total Population 66% Abilene ) 105,334 33 Stephensville ) 20 Cities having 3 to 4.5 ppm fluoride (1949- 49) ........ 81 Lamera ) 78 Lubbock ) Total Population 38 Plainview ) 163,382 62 Amarillo ) Wisconsin different concentrations of fluoride in the public water sup- Stevens Point little or no fluoride (1945 -49) ......136 Population 16,550 Sheboygan Green Bay, 2.6 ppm fluoride (1945 -49) .............131 0.03 ppm Population 52,443 Wisconsin 10.0 Sheboygan, Population 40,638 Little or no fluoride (1940 -44) ....................148 24.0 After fluoridation ( 1945- 49) .......................138 Colorado- California 22.4 San Francisco little or no fluoride.... 1938 151 Population 1,131,110 ..................1947 149 Denver 1.2 ppm fluoride ............1939 137 Population 316,124 ...................1947 132 5 TABLE IV Comparison of survival rates of different types of cancer 12 months after microscopic diagnosis, expressed as per cent survival. Source (17) and (18). San Francisco Denver Little or no fluoride 1.2 ppm Cancer, all types ...............70 ;0 66% Cancer of stomach ..............34 33 Cancer of lungs and bronchii ..16 20 Cancer of breast ................44 39 Cancer of uterus ...............83 78 Leukemia .......................32 38 Lymphomas ....................58 62 TABLE V Comparison of deaths related to pregnancy in cities with different concentrations of fluoride in the public water sup- plies. 1940 through 1944. Source (22). Green Bay Fond du Lac Sheboygan 2.5 ppm 0.5 ppm 0.03 ppm Death Rate (per 1.000 population) ..9.10 12.1 10.0 Still Birth Rate (per 1,000 live births) 22.5 20.7 24.0 Neonatal Rate (per 1.000 live births) 25.1 22.7 22.4 TABLE VI Comparisons of death related to pregnancy In cities with different concentrations of fluoride in the public water sup- plies, 1945 through 1949. Source (22). Green Bay Stevens Point Sheboygan Sheboygan 2.5 ppm 0.2 ppm 1.2 ppm .03 ppm (Before fluoridation) (1940 -44) Death Rate (per 1.000 Population) 9.1 9.0 9.7 10.0 Stillbirth Rate (per 1.000 live births) 17.5 15.0 19.1 24.1 Neonatal Rate (per 1.000 live births) 24.6 32.0 22.7 22.4 Maternal Rate (per 1.000 live births) .7 2.6 1.1 1.7 Infant Rate (per 1,000 live births) 33.6 46.4 30.8 30.9 Wisconsin communities during two successive 5 year periods. The well recognized stresses of pregnancy and the sensitiveness of the developing fetus to changes in its environment could be expected to re- flect toxicity if any such existed in the water supply. Yet there is no important or consistent difference in the frequency of deaths at term (still birth), im- mediately after delivery (neonatal), during the first year of life (infant) nor in the mothers themselves in the cities whose water supplies contain from 0.03 ppm to 2.5 ppm of fluorine. Nor is there any signif- icant alteration of these patterns in the city of She- boygan during the 5 year period following the raising of its fluoride concentration from 0.03 ppm to 1.2 ppm. Fears are often expressed that even physiologic concentrations of water -born fluorine may have an adverse effect upon suffers from certain organic dis- eases. In Tables VII and VIII' appear the vital statistics from these same Wisconsin communities over the same successive 5 year periods, 1940 -44 and 1945- 1949. The frequency of the following disorders are reported: health diseases, cancer, cerebral hemorrhage (stroke), nephritis (degenerative diseases of the kid- WATER FLUORIDATION neys), pneumonia, diabetes, tuberculosis, influenza and appendicitis. The utter lack of correlation between the numbers of deaths from any of these diseases and the naturally- occurring fluorine content of the respec- tive municipal water supplies is obvious, including the comparison of pre- and post- fluoridation data in She- boygan. The Commissioner of Public Health of She- boygan, G. C. Hildebrand, M.D., advises: "I am en- TABLE VII Comporison of death rate of some representative diseases In cities with different concentrations of fluoride in the public water supplies, 1940 through 1944. Source (22). Green Bay Fond du Lac Sheboygan 2.5 ppm 0.5 0.03 Leading Causes of Death 298.5 340.9 (Rates per 100,000 Population) Cancer ..131.6 Heart Disease ...........307.6 137.7 360.9 311.0 Cancer ..................127.2 195.5 148.1 Cerebral Hemmorrhage .. 93.9 130.8 97.9 Nephritis ................ 51.0 114.7 41.3 Pneumonia .............. 27.7 28.7 28.5 Diabetes ................ 34.6 38.2 32.5 Tuberculosis ............ 17.7 19.8 32.5 Influenza ................ 17.7 6.6 8.4 Appendicitis ............ 12.5 5.1 4.4 TABLE VIII Comparison of death rate of some representative diseases in cities with different concentrations of fluoride in the public water supplies, 1945 through 1949. Source (22). Green Bay Stevens Point Sheboygan Sheboygan 2.5 ppm .02 ppm 1.2 ppm .03 ppm (Before fluoridation Leading Causes 1940 -44) of Death Heart ........279.7 298.5 340.9 1 311.0 Cancer ..131.6 136.2 137.7 148.1 Cerebral Hem - morrhage ...103.3 77.0 124.2 97.9 Nephritis . 28.7 32.0 21.7 41.3 Pneumonia ... 19.0 33.2 23.9 28.5 Diabetes ...... 20.9 34.3 24.4 32.5 Tuberculosis .. 7.8 14.2 19.4 32.5 Influenza .. 8.2 2.4 4.5 8.4 Appendicitis .. 5.2 3.6 2.3 4.4 TABLE IX 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 Infant Death Rate (per 1000 live births) 28.2 25.5 30.8 32.4 36.0 31.6 23.6 19.4 20.1 17.9 Death Rates: (per 100,000 population) Heart Disease .. 367 390 477 430 472 395 403 428 377 404 Nephritis 50 57 68 57 77 51 52 47 38 11 Intracranial Lesions .. 120 118 139 131 149 143 111 104 101 150 closing a chart giving the number of deaths of the more common causes of death. There is nothing in our statistics in the last ten years to indicate that fluoridation has had any adverse effects on the health of the people of this community. "' The addition of sodium fluoride to the water sup- ply of Grand Rapids, Michigan, was initiated on January 25, 1945. Only a trace (0.1 ppm) of naturally occurring fluorine was previously present in the water obtained from Lake Michigan and the concentration is now supplemented to 1.0 ppm. Table IX has been pre- N pared from vital statistics of 1941 -1950 furnished' by W. B. Prothro; M.D., Public Health Director of Grand Rapids, and sets forth the infant death rate and the death rates due to heart disease, nephritis and intracranial lesions (including brain tumors, strokes and other disorders arising within the skull.) In comment, Dr. Prothro writes: "We have not observed any significant change in the vital statistics of Grand Rapids since the inception of our fluorida- tion program." Dr. C. V. Tossy, Associate Chief of the Public Health Dentistry Section, Michigan De- partment of Health, remarks: "Vital statistics in Grand Rapids have been studied in comparison with the rest of the state, and there are no differences that could be attributed to fluoridation of the water. There have been no adverse effects of any kind noted." 3 The City of Janesville, Wisconsin, whose water sup- ply was naturally free of fluorine, started the addition of sodium fluoride in the proportion of 1 ppm on July 26, 1948. Fred B. Welch, M.D., the City Health Com- missioner, writes: "An evaluation of our vital statistics show no adverse effects have been noted with regard to chronic diseases of the kidneys, circulatory system or cancer and diabetes mellitus. "" Additional information of value has been received in response to inquiry directed to the president of the local medical society' and to the community health officer," respectively, of each of fifteen cities of more than 10,000 population which has had a water fluoridation program in effect more than three years (initiated before January 1, 1950). The substance of the questions to the practicing physicians is 1) "Do you notice any change in the course of certain dis- eases since fluoridation was started ?" and 2) "Do any of your local physicians forbid the use of the fluoridated water in treating such patients ?" The dis- eases specified were cancer, diabetes and inflammatory or degenerative diseases of the circulatory system and of the kidneys. The second question was repeated in the query to the district health officers, along with a request for current information on vital statistics and dental results. We failed to receive answers to these two questions from three of the communities. The replies from twelve,", 1. 1, 21, 1 four of which have been quoted verbatim, are unequivocally in the nega- tive. There is no dissatisfaction or concern reported among the physicians in the communities in which fluoride supplement up to physiologic concentration has now been added for from three to eight years. No physician in these communities is reported to for- bid the use of water from the municipal supply and substitute water from another source. This is not of- fered as scientific .evidence but as proof of the at- titude of the physicians who treat the sick of these twelve cities whose total population exceeds 785,000 persons, according to the U. S. Census of 1950. Returning to consideration of areas in which the natural concentration of fluorine in water equals or exceeds the ideal figure of approximately 1 ppm, it has already been stated that more than three million persons have used such concentrations (up to 5 ppm) all their lives without reported ill effects on health" It is probable that analyses in other areas will make this number larger, as a recent report" from Iowa indicates that a considerable percentage of people in that state are using water containing physiologic, or higher, concentrations of fluorine. Evidently, the physiologic daily dose must be exceeded several -fold WATER FLUORIDATION for very proldnged periods before storage of fluorides in bone becomes detectable to X Ray examination. This condition of "bone fluorosis" is the next de- tectable sign after dental fluorosis (mottling) that ideal intakes are being grossly exceeded. Its existence has not been demonstrated in persons receiving up to five times the amounts from natural sources or by any artificial fluoridation program. An X Ray survey of 31 inhabitants of Bureau, Illinois, residents of that community for from 18 to 68 years, and using, a water supply providing 2.5 ppm of fluoride, revealed none of the hardening of the bones that characterizes fluorosis. A study" by the same authors of 86 inhab- itants of Kempton, Illinois, where the content of fluorine in water varies from 1.5 to 3.0 ppm also failed to show fluorosis of bone. At a much larger intake (8 ppm) a survey" already cited, was made by a team consisting of three physicians, three nurses and one dentist in the community of Bartlett, Texas. Com- plete physical examinations, medical history, urinal- ysis, blood counts and X Rays of bone were made on everyone resident there for more than 15 years. Over 3000 X Rays were taken and were submitted to the specialists in two well -known clinics for inter- pretation. From one consultant came the opinion that in 12 per cent of the individuals over fifty years of age a minor degree of change in bone structure was present but was without clinical significance. In the neighboring town of Cameron, with three times the population, the same study was made on one out of three persons. Although the concentration of fluorine in the water in. Cameron was only 0.3 ppm almost identically that of St. Louis, no evidence was de- veloped to show that the residents of either com- munity were healthier in any way than those of the other. Mottling of the teeth, of course, was common and caries infrequent in the people of Bartlett, in comparison with those living in Cameron. It is outside the range of our purpose to review the chronic toxic effects that appear with still higher in- takes of fluoride. These are seen in industrial poison- ing and usually involve intakes by breathing dust - born fluoride in enormously higher amounts than those defined as appropriate to a water fluoridation project. It has been shown that with daily intakes up to 5 mg. of fluorine (five times the ideal dose) excre- tion by urine, sweat and feces keeps up with intake,' only a small fraction being taken up by the teeth. The concentration of fluoride in the urine becomes, therefore, a good indication of the intake until toxic doses are reached and urinary output lags behind bone storage of fluorine. Therefore, some idea of the magnitude of the intake of those industrial workers who have shown X -Ray evidence of bone fluorosis, both with and without symptoms, is revealed in their average reported urinary concentration of 16 ppm in one study'- and of 10 ppm or more in another." We have, therefore, examined the data submitted by direct medical study of persons using fluorine in physiologic, or larger, concentration in the water supply and the comparative vital statistics revealing incidence of a variety of diseases in communities whose waters bear various concentrations of fluorine, both above and below the ideal level. A third method of determining the effects of fluorine within a re- stricted range of daily dosage is that involving the experimental feeding to humans and to animals. We have cited twice the study made by McClure" and Mitchell (Professor of Animal Nutrition, University of 7 Illinois) and co- workers. They fed to five healthy young men a diet supplemented by fluorine in various forms at different doses up to 6 mg. per day over periods of 21 to 26 weeks. Chemical analyses of all food and fluid and of all excreta (urine, sweat and feces) were made at intervals for fluorine content, hence a most through and critical "balance study" was carried out. Four of their important findings and conclusions will be quoted directly: 1) "The elimination of absorbed fluorine via the urine and perspiration is practically complete when the quantities absorbed do not exceed 4.0 to 5.0 mg. daily." 2) "The proportion of fluorine excreted by the kidneys fell during periods of higher environmental temperature and the proportion excreted in the sweat rose under these circumstances." 3) "There was no significant retention of fluorine in the bodies of these young adult men when total daily fluorine ingested did not .exceed 4.0 to 5.0 mg. daily. The data suggest that these may be the limits of fluorine which may be ingested daily without an appreciable hazard of body storage of fluorine." 4) "The consistent evidence of practically complete fluorine equilibrium in these human subjects would seem to indicate also that exposure to domestic waters, such as Galesburg, Illinois, drinking water containing 1.8 to 1.9 ppm flu- orine, or any drinking water which contributes an average of not more than 3.0 to 4.0 mg. fluorine to the ingests (total intake of fluids and solids) is not liable to. create a public health hazard of cumulative toxic fluorosis." Four of their five. subjects were care- fully examined at the end of the study period for signs of possible injury to health. Complete physical examinations, blood counts and smears, urinalysis, dental examination and X -Ray of the teeth were not revealing. There was no inflammation of the. skin to indicate irritation from the unusually high amounts of fluorine in the sweat. The findings of McClure and Mitchell substantiated earlier balance studies by Machle and Largent' in 1943, although the latter reported storage at total daily intakes of 6 mg. Failure of Machle and Largent to measure the fluorine content of sweat may account for such discrepancy between intake and output at these comparatively large intakes. The results of these ex- haustive balance studies are such as to let us say with confidence that we know enough of the means by which the body disposes of fluorine at levels of daily intake up to 5 mg. to predict that intakes of the order of 1 mg. daily over however long a period will not cause injury to health. A very large body of research is reported on ex- perimental animals fed fluorine in various chemical combinations in a considerable dosages range. While research on member of one species cannot necessarily be applied to those of another species (including man), certain observations as to margins of safety and variations in absorption of different chemical compounds of fluorine are of interest, particularly in considering certain objections to the fluoridation of water. In experiments on rats, Roholm" found that a dose of 1 mg. of fluoride ion per kilo (2.2 pounds) daily would induce incipient mottling of the enamel; the comparable intake for a man weighing 154 pounds would be one quart of water daily with a concentra- tion of 70 ppm. Five times this amount would cause bone fluorosis; ten times the original dose (or the equivalent of one quart of water daily, with a con- centration of 700 ppm) regularly causes signs of ill WATER FLUORIDATION health. Largent fed 65 mg. of fluorine (as sodium fluoride) daily to two dogs from the age of eleven months. After five and one half years the animals were sacrificed and no noteworthy changes were found upon miscroscopic examination of the organs or bones; during ,life no changes in the bones detectable by X -Ray examination developed.3B In evaluating such a report, one must take into account the fact that a cor- responding daily dose for a man would be enormously larger than the 1 mg. amount considered ideal for den- tal purposes. Similar studies have been carried through several generations of dogs without dis- cernible effects on their health, yet, it must be re- peated, sensitiveness of different species to the effects of fluorine differ sufficiently that literal application of data on dosage cannot safely be carried over from one species to another. Important differences in the absorption from the in- testine of fluorine, depending upon the form in which it is ingested, was brought out in the publication" by Greenwood in 1946. He fed fluorine in a dosage of 5 mg. per kilo (2.2 pounds) to puppies as sodium flu- oride, as bone meal and as defluorinated phosphate. It was noted that dental fluorosis appeared in the pup- pies receiving sodium fluoride, but not in those re- ceiving the same quantity of fluorine in the other forms, an indication that fluoride ion in bone meal and in defluorinated phosphate is less readily absorbed from the intestine than is sodium fluoride. Jackson came to the same conclusion and reported" his feeding experiments on immature and adult rats, showing conclusively that the concentrations of fluorine differs considerably in different bone meals and cooked bone, depending both upon their origin and particle size. Jackson demonstrated the variability of absorption from the intestine of fluorine in bone meals due to these and to other factors and cited other investiga- tions in animal and human feeding experiments to the same point: One of McClure 's2 salient conclusions was that absorption of fluoride supplements is largely dependent upon their solubility (i. e., upon the ease with which they dissolve in water or in digestive juices). As might be expected, in McClure's balance studies, previously described, from 35 per cent to 50 per cent of the fluoride ingested in bone meal was not absorbed from the digestive tract and appeared in the feces. To conclude this inquiry into the most pertinent ex- periments that have been performed on animal spe- cies, let us return to man and cite one series of ob- servations upon the feeding of sodium fluoride in capsules to patients dying of incurable, malignant (cancerous) states. Black and his co- workers report- ed' upon the results in 70 such individuals, adults and children. Children with leukemia, a deadly disease of the blood forming organs, received a total daily dose of 80 to 200 mg.; the average adult dose was 320 mg. daily. The usual period of medication was three or four months and even in periods up to six months no evidence of acute or chronic intoxication was de- tected. Microscopic examination of organs after death from the disease also failed to reveal damage to tis- sue. One patient is reported to have received a total of 5600 mg. intravenously in doses of 400 mg. over a period of nine days without apparent toxicity! Numer- ous investigators report the personal ingestion of as much as 250 mg. at a single dose although an esti- imated dose of 105 mg. has been reported to be fatal. These acute, short -term experiments are not pertinent j to the consideration of. a water fluoridation program with a daily dose of about 1 mg. of fluorine to the in- dividual, young or old, sick or well. They are in- troduced only to demonstrate that surprisingly large quantities of this chemical element, fluorine, have been taken daily under careful scrutiny, often over considerable periods of time, by man and animals without detectable ill effects. We have, then, considered the evidence of all types gathered by systematic study of individuals and of vital statistics and by laboratory investigation and we have not encountered any hint of a health hazard in the ingestion of water fluoridated naturally or by sup- plement to the physiologic level or even to a concen- tration four times as . high. The reasons why no evidence of injury to health has occurred or is to be anticipated have also been examined. They may best be summarized by the statements: 1) The body shows no tendency to store fluorine in physiologic dose, ex- cept for a very small fraction in the developing teeth. 2) Excretion through the kidneys and skin of absorbed fluorine in ideal dosage is practically complete. 3) On the basis of all evidence, these physiologic (func- tional) processes are unchanged at levels of intake of fluorine at least four times the ideal daily doses, thus providing a very wide margin of safety for the consumer of properly fluoridated water, whatever his age or state of health. 4). There is strong evidence to support the view that this factor of safety extends to intakes of eight times the ideal daily dose and there is no published evidence to the contrary. Freedom to dissent from a popular view and the right to advance one's opinion on any topic are among the most precious heritages of those who live under a representative form of government. Part of the price which we gladly pay for -the exercise of these rights is, in delay in instituting programs which are either highly desirable or vitally necessary. Because of the need for accurate definition of the problem to be faced and the merit of a specific proposal for at- tacking it, confusion and controversy mark a predict- able stage through which the most meritorious pro- posal must pass. These result from impatience or inadequate explanation by its proponents and from honest doubt, unreasoning anxiety, lack of under- standing, suspicion of motives, sheer ineptness, or self- seeking in various degrees on the part of oppon- ents. These evidences of human imperfection form a pattern familiar to one who has studied the progress of legislative proposals to supplement too low a nat- ural concentration of fluorine in a community water supply. Every elected official of a municipality in which fluoridation is contemplated is duty bound to consider the views of the objectors as well as those of the advocates. It is important that he be fully in- formed as to the nature and merit of the opposition. Those of us with scientific aptitude and training who, as members of the medical profession, enjoy the pub- lic trust are under the dual obligations of studying the issues which have been made to appear controver- sial and to proclaim which arguments and attitudes have scientific merit, classifying as irrelevent those which lack such quality. In the enormous literature on fluorides and on fluoridation of water, scientific publications or public testimony in opposition have appeared from six in- dividuals in particular whose scientific. training and experience qualify them as deserving of respectful at- tention and inquiry into the reasons for their views. WATER FLUORIDATION They all appeared before the Delaney Committee in opposition to fluoridation of water. Since their op- position is repeatedly cited by those who have little claim to aptitude or opportunity for objective evalua- tion of the problem, detailed comment is in order. 1) Dr. Robert S. Harris, Professor of Biochemistry of Nutrition, Massachusetts Institute of Technology, brought his views into public attention in 1951 in a letter'" to a newspaper and made statements therein about the behavior of fluoride in the body which, when he defines the concentration, are at variance with the overwhelming weight of evidence or which leave the concentrations undefined and therefore simp- ly, useless as a basis for discussion. The 12 points into which his letter is arranged constitute an odd mixture of statements of widely supported fact, of allegations which cannot be documented, of others which/ have been disproven and of judgments with which the informed reader may differ. Certain of his arguments were later elaborated in the form of 19 questions in testimony before the Delaney Committee (of which, more later). They have been thoughtfully answered" by Gerald J. Cox, Ph.D., Director of Den- tal Research, School of Dentistry, University of Pitts- burgh, a distinguished contributor to our factual knowledge of the effects of fluorine in human metab- olism. Dr. Harris' questions reveal principally his wholly _understandable wish that more were known of the ultimate cause (if there be only one) of dental caries. They raise no points, however, whose answers can be construed as being unfavorable to a fluorida- tion program. This consideration has, obviously, im- pressed itself upon Dr. Harris who has. subsequently (1953) written a letter'- stating that he neither sup- ports nor opposes fluoridation. This marks a decided shift from his position taken in 1951 and expressed in 1952 before the Delaney Committee. 2) V. O. Hurme, D.D.S., is Research Director, For- syth Dental Infirmary, Boston, Mass., in which in- stitution dental service is provided for children. He is the author of a paper'" entitled "An Examination of the Scientific Basis for Fluoridating Populations" and of a number of public statements questining the ad- visability of fluoridation of water supplies. His article produces no evidence that fluoridation is either dan- gerous or ineffective. A study of his paper leaves the reader with the convictions a) that the author has failed to review the voluminous literature which gives concrete evidence upon points about which he confesses himself to be in doubt and b) that his use of such terms as "mass medication" and "compulsory" procedures reveal an emotional bias which casts doubt on his objectivity. A lengthy comment on points which Dr. Hui-me has characterized as controversial has been made subsequently in the same publication by David B. Ast, D.D.S., Director of the Bureau of Dental Health, New York State Department of Health who has been, unlike Dr. Hui-me, long noted for his contributions to the scientific literature on this sub- ject. Those who find themselves alarmed by Dr. Hueme's wish to delay fluoridation pending the estab- lishment of criteria which he does not, himself, define should read Dr. Ast's rebuttal. To quote the latter verbatim, "Many of the accepted public health pro- cedures were generally applied with far less study and knowledge of the mechanism by which they worked or side reactions than is known about water fluoridation. I know of no public health procedure, including water chlorination, Pasteurization of milk, 9 or vaccination which has had the intensive and com- prehensve study before it was applied as water flu- oridation has had." 3) The anti fluoridation pamphleteers have made a major issue of a premature announcement of research by Alfred A. Taylor, Ph.D., at the Biochemical In- stitute, the University of Texas (Austin). Dr. Taylor set out to study the time of appearance of malignant breast tumors in a strain of mice used by many lab- oratory workers because they are bred to be specific trait of developing such tumors spontaneously in nearly 100 per cent of animals. Dr. Taylor proposed to give different concentrations of sodium fluoride in the drinking water of different groups of the mice and to observe whether or not the age at which tumors appeared would show any correlation with their re- spective intakes of fluorine. As is their hereditary trait, practically all of the mice died with well developed tumors of the breast. Dr. Taylor, unfortu- nately, sent a letter to Mrs. Marion E. Lyon (of whom more anon) before he had carefully reviewed all the pertinent data in his experiment and even before pub- lication of his findings in a scientific journal. She, as did other pamphleteers, quoted him at length and re- produced his tabulated data to show that mice thought to be receiving 1 ppm and 10 ppm of fluoride in drink- ing water developed the breast tumors at an earlier age than those receiving distilled water. This created a furor, as may be imagined, and was used effectively to cause such alarm in lay minds that plans for flu- oridation in several communities were delayed for the time being. A furor on a different plane, however, re-' sulted when a research team from the U. S. Public Health Service reviewed Dr. Taylor's plan of pro- cedure and found" that the solid food of the exper- imental animals consisted of a chow which, itself, contained 42 ppm of fluorine! As aftermaths, Dr. Edward Taylor, Director of Dental Health of the Texas State Department of Health wrote an article" entitled "Facts Relative to Rumors that Fluoridation Causes Cancer," which was published promptly in the Texas Dental Journal in refutation of the rumors. Moreover, Dr. Chauncey Leake, Vice - President of the University of Texas and one of the most respected men in the field of the medical sciences, wrote a let- ter" to Dr. Edward Taylor expressing his regret over the incident and making it plain that "there is no contraindication of fluoridation of drinking waters." These, then, are the facts about the research and its attendant publicity which have given rise to the allegations that water fluoridation programs increase the risk of the development of cancer or that the ef- fects of drinking fluoridated waters may be partic- ularly hazarodus for persons who have cancer! 4) Dr. A. L. Miller is a former State Health Of- ficer of Nebraska, from which State he is now a U. S. Representative and a member of the Delaney Com- mittee, as such, he made a separate statement and has made other addresses on fluoridation before Con- gress, taking a position in opposition to programs for the fluoridation of community welter supplies. His arguments disregard the weight of evidence and do not show regard for the realities of the situation in his recommendation that fluorine be provided by means of tablets or supplement in milk, as will be shown later. He has tortured the meaning of words in attempting to "interpret" the forthright approval by the American Medical Association of the fluorida- tion of water supplies. He has fallen into serious WATER FLUORIDATION factual error in using inappropriate vital statistics in evaluating the incidence of circulatory diseases as a cause of death in Grand Rapids, on which point he has been most clearly and courteously set straight18 by W. B. Prothro, M.D., Public Health Director of Grand Rapids. He has presented no acceptable evi- dence that fluoridation is either dangerous, ineffective, or undesirable and his testimony has been challenged in detail elsewhere." His statements have, inevitably, been widely reproduced-as a scientific opinion in op- position to fluoridation. If he claims to speak with scientific, rather than. political authority, however, his attitude leaves much to be desired. 5) Margaret C. Smith, Ph.D. and 6) her husband, Howard V. Smith, are distinguished chemists who have for many years been associated with the Univer- sity of Arizona, the former in human nutrition and the latter in agricultural research, respectively. They were among, the first to show by animal experiment that mottled teeth could be produced by an excess of flu- orine in the drinking water; among their many valuable contributions are observations on the in- creased incidence of fluorosis at higher environmental temperatures with a given intake of fluoride. In their testimony before the Delaney Committee (loc. cit., p 1602 -1614, 1614 -1623) they stress the value of flu- orine in reducing the incidence of dental caries and state their acceptance of the work of the U. S. Public Health Service in epidemiological studies of naturally fluoridated water and in experimental studies of water supplemented by fluoridation (such as in Grand Rapids). They expressed opposition to the extension of fluoridation programs to other cities (as of 1952) principally in their shared belief that sufficiently exact climatic data were not then available to set a con- centration for a given community which would be high enough to give maximum caries prevention, yet low enough to prevent obvious dental fluorosis. A careful reading of their testimony makes it clear that they consider even "questionable" or "very mild" degrees of dental fluorosis, as defined by the U. S. Public Health Service, to be-not only toxic manifesta- tions of fluorine intake but as esthetically objection- able. Now, the definition of "very mild" dental flu - orosis postulates only a few very small, whitish, non - opaque areas on . the back teeth, but not involving as much as 25 per cent of any tooth surface. Such are not detectable on examination by the average physician or dentist, much less by the individual who has them. It is therefore, the accepted opinion that they are not objectionable and that their presence in as many as 10 to 15 per cent of persons is not too high, a price, to pay for the partial protection against caries obtained by fluoridation. It is doubtful that the Smiths are on sound ground in differing with the dentists on this point and insisting on classifying such findings as dental fluorosis, as defiguring and as evi- dence of fluorine toxicity. Evidence has been pub- lished both before'- 10 and since" their testimony to substantiate their view that the generalization is unsound that 1 ppm of fluoride is the ideal concentra- tion for every community in the United States, re- gardless of climate, as will be elaborated. There can be no quarrel on this point between the Smiths and many advocates of fluoridation programs. Such is the extent of the published dissent from the almost unanimous view of those qualified through training and experience to express themselves on the scientific aspects of the situation. That the recorded 10 anxiety as to possible, usually unspecified ill effects on the part of so small a minority has been rejected as contrary to the evidence or irrelevant is obvious in the approval of fluoridation by the respected, re- sponsible 'medical and dental organizations yet to be listed. There is an equally impressive roster of ad- vocates among men of science engaged in teaching, in research, in public health activities and in water engineering. The testimony of the opponents quoted above would be a slender reed to flourish in aggres- sive opposition. It would be fatuous to assume that such constitutes the backbone of determined efforts to prevent the wider adoption of fluoridation. It is a simple matter to identify the sources of strength be- hind the avowed and open resistance to fluoridation but assay of their various motives is sometimes dif- ficult. Several groups of pamphleteers regularly spread their antifluoridation documents in commun- ities which are entertaining proposals for fluoridation. Pertinent data as to membership, methods of arriving at policy, organization and sources of funds are not often revealed. Close study of their printed material gives a clear view, however, of their standards of re- porting and what, for want of a better term, may be termed their sense of responsibility. Space does not permit the inclusion of the detailed critique which has been prepared. A few allusions, quotations and comments should be sufficient to characterize them. Printed and mimeographed material from the follow- ing three sources have been liberally circulated in metropolitan St. Louis and have been effective, hither- to, in their purpose. 1) A compilation of mimeographed material was re- ceived on November 10, 1951, from the Water Com- missioner of St. Louis, Mr. Thomas J. Skinker, at the St. Louis Medical Society. It bears the name and address of Mrs. Marion E. Lyon, 415 South Main Street, Geneva, N. Y. and the notation that it was ob- tained from her on October 25, 1951. It consists of 14 sheets of paper with 46 numbered items of ex- cerpts from newspaper stories, scientific publications, speeches and letters addressed, presumably, to Mrs. Lyon. The authors are so various in occupation as to defy classification and their attributed claims to authority are, at times, obscure. Reference will be made to the paragraphs as numbered, for the con- venience of those in possession of copies of this document. The comments to be made are concerned with views attributed to those individuals whose stated professional position immediately rouses the interest of the reader. As might be expected, the opinions of Alfred Taylor, Ph.D., the unhappy outcome of whose observations on breast cancer in mice will be recalled, are set forth in paragraphs 1, 16 and 37, paragraph 16 being devoted to his letter, itself to Mrs. Lyon. The views of Dr. V. O. Hurme," appear in paragraphs 24 and 35 and Dr. Robert S. Harris' letter40 of February 25, 1951, is quoted, in part, in paragraph 33. The portion of Dr. Harris' letter testify- ing to the effectiveness of fluoridation is not repro- duced. To the uninitiated, the appearance of testimony by Dr. Huntington Williams, M.D., Health Commissioner of Baltimore, in paragraph 11, by Winston H. Tucker, M.D., Health Commissioner of Evanston, Illinois, in paragraph 26 and by Dr. J. L. T. Appleton, Professor of Microbiology in the School of Dentistry, Univer- sity of Pennsylvania, in paragraph 34, that fluoridation should be undertaken only as an experiment comes as WATER FLU( a shock until one notes that these statements are undated. Inquiry shows that Dr. Williams subsequent- ly recommended" on March 3, 1952, fluoridation of the water supply of Baltimore and this was put into effect on November 26, 1952. Dr. Tucker's statement was made in October of 1951; his advocacy of fluorida- tion for other communities has been made clear." Dr. Appleton's quoted statement was made in May, 1950; he is a declared advocate of fluoridation and, as a member of the Ad Hoc Committtee on Fluoridation of Water Supplies, National Research Council, partic- ipated in the preparation of that Report' which recom- mended fluoridation in November, 1951. These gentle- men are distinguished students of the effects of flu- oridation, of conservative and mature judgment and in positions of grave responsibility. They had no hesitancy about counselling a cautious approach in earlier years. Statements in opposition to fluoridation are attributed in paragraph 26 to Dr. E. V. McCollum, Professor Emeritus of Biochemistry of Johns Hopkins University, one of the great scientists of his genera- tion, whose textbook is known to every medical stu- dent of the past fifty years. Mrs. Lyon has released material quoting one Harold Lamb, D.M.D., who quotes an alleged letter dated August 21, 1950, at- tributed to Dr. McCollum, in these words. "This meas- ure of prevention, in some measure, the high inci- dence of dental caries, is in the experimental stage. So far as I am aware, it has not been ' found to be effective where it has been tried." Dr. Lamb there- upon assures the reader that this statement "may be verified at sources by any who wish to take the trouble to write." Upon inquiry, Dr. McCollum has denieda0 being the author of such a letter and has challenged the Citizens Medical Reference Bureau to verify its existence which they have not, apparent- ly, undertaken to do. An issue far more grave than mere obsolescence of viewpoint has been introduced by the inclusion of _naterial whose authenticity has been repudiated. No explanation from Mrs. Lyon, Dr. Lamb or the Citizens' Reference Bureau has come to our attention. In portions of the Lyon document which purport to abstract original source material from the scientific journals, no pretence of reporting objectively the whole purpose and conclusion of each author is evi- dent to one who has studied the original publications. In paragraph 22 appears an excerpt attributed to the April, 1951, issue of Prevention, a Magazine Devoted to the Conservation of Human Health (of which, more later). This excerpt is written in such a way as to give the reader the impression that all the material in it expresses the findings and viewpoints of the studies', '• ", " on fluoride "balance" and the dif- ferences in solubility and absorbability between bone meal and sodium fluoride, reviewed earlier in con- siderable detail. Whoever prepared the material for publication in Prevention, however, has very care- fully selected certain data of the authors and written w it up in such a way to include his on comments as though they were the remarks of the authors. He has omitted all data, references and conclusions un- favorable to his cause. Jackson'' and Largent', " would be amazed to learn that an uninformed, person, read- ing paragraph 22, would prabably draw the con- clusions that they considered bone meal to be a "safer or more appropriate method of i administering fluorine than by the fluoridation of the water supply for human beings. And McClure"' one of the most RIDATION prolific contribut rs of studies on the metabolism of fluorine, would never discover, in reading the mixture of his data taken !,out of context and special pleading by the reviewer, that he, himself, was a consistent advocate of fluoridation. The evidence advanced above should be sufficient to thoroughly discredit the printed matter emanating through the Lyon document; from the Citizen's Refer- ence Committee and in Prevention. A further com- ment on the last is in order. Perusal of several re- prints have shown a continuing devotion to the ex- ploded48 views of Representative Miller and of Dr. Alfred Taylor more than a year after Dr. Leake's repudiation of that affair.15 In response to request, the assistant editor of Prevention sent a copy of the issue of June, 1953, with a cordial letter stating: "As you will see, we do not advocate the health policies of any special group. We do research in medical and scientific magazines and publish the results of our findings as they relate to prevention_ of disease. It is our opinion that a correct diet and way of life will in general prevent many of the diseases of twentieth century life." A study of the issue submitted reveals that such a disclaimer is less than candid. The char- acter of the advertising and of the news articles leads only to the conclusion that this magazine follows the line of thought known as Naturopathy. It includes an antifluoridation article by the same lay author whose diatribe against fluoridation was published in February, 1953, issue of Harpers Magazine and con- sists of the usual mixture of allegations which form such a familiar 'pattern. While they concentrate on the "Operation Rat Poison" theme to characterize the fluoridation movement, they seem most concerned" about the use of the community water supply as a vehicle for fluorides and they occasionally suggest that fluoride intake for reduction of dental caries may be desirable if it is ingested in some other vehicle. One wonders whether this press has sent pamphlets into those communities which have installed deflu- oridation plants in order to reduce the high concentra- tion elsewhere as they oppose supplementing the low concentration in St. Louis and St. Louis County. If not, their devotion to "natural" water is tainted, if the former adjective can be fairly applied to any aqueous solution treated as is our own to make it acceptable from the esthetic viewpoint as well as from considerations of self - preservation. Clearly, the human ingestion of adequate amounts of fluoride as bone meal or pablum is acceptable to this publication, as stated in the excerpt attributed to it in paragraph 22 of the Lyon document. Without any imputation as to the motivation of this publication, its position is quite inconsistent, it has no discernible scientific status and its standard of reporting makes any of its state- ments on this subject unacceptable as evidence. The product of a third pamphleteer, W. D. Herrstom, of Faribault, Minn., is worthy of note. It is entitled "Americanism Bulletin," selling for 'ten cents per issue. The September, 1951, issue" was sent into St. Louis as recently as July, 1953. It . contains "25 rea- sons why community water supplies should not be fluoridated." These contain no evidence of either scientific or educational value, but express concern lest a saboteur' fatally poison an entire community through excessive fluoridation by the mere twist of a valve. Fluoridation is described also as a subtle enemy plot to weaken the mental powers of the American people in order that they will fall an 11 WATER FLUORIDATION easy prey to "Satanic dictatorship." Another issue .ap- peals strongly to fear of foreign domination and de- scribes the entire fluoridation movement as a plot by socialistic stooges of Mr. Oscar Ewing. The implica- tion is plain that any supporter of fluoridation is necessarily an admirer of Mr. Ewing's politico -eco- nomic views! This is entertaining grounds for polemics but is far afield from a discussion of the merits of fluoridation or of possible hazards to health. The opponents of fluoridation whose efforts are chiefly confined to pamphleteering at ten cents a copy tend to quote one another and operate in effect, as a team. All have laid much stress on the failure of the Delaney Committee to approve the principle of fluoridation of community water supplies. It is fair to state that many open- minded, genuinely inquiring per- sons without the ability to evaluate scientific evidence have been much impressed by the Delaney Report " and such is the natural reaction to what purported to be a congressional hearing of scientific testimony. The Report itself is, we believe, very fair in inten- tion It reflects a clearly- expressed sense of respon- sibility on the part of the members of the Commit- tee not to reach a hasty conclusion nor one which might conceivably result in harm to the population of any community in the United States. The Report itself, however, is much fairer in tone than was the atmosphere of the Hearings, as a close reading of the latter makes obvious. A contentious attitude, particularly toward witnesses from the United States Public Health Service, seems to have been displayed by the Chief Counsel and by one of the members of the Committee and moved Represent- atives Paul C. Jones of Missouri and Walt Horan of Washington, themselves members, to protest against a "prosecuting" attitude toward certain advocates of fluoridation. We shall not go into a detailed commentary here, as that has been done. previously" with, we believe, full effectiveness. We would characterize the Report, not as bad, but as disappointing in that it 1) failed to give due emphasis to the better evidence in the Hearings and 2) sought for perfect and complete knowledge in a scientific field unlike that demanded of any other in which reliable data for day -to -day application are available. To deny the validity of the evidence for the safety of fluoridation today pending the completion and extension of experimental inves- tigations is to disregard what has already been learned and to introduce the concept of a conflict between practice and investigation which is not valid. The ad- ditional views, filed as a separate report by Rep. Miller have been commented on previously. He is in factual error in the notion that only persons under 8 years of age will be benefited by fluoridation and he is guilty more than once of "interpreting" state- ments of the American Medical Association to derive meanings which are contrary to the accepted usage of the English language. In response to a recent in- quiry, George F. Lull, M.D., Secretary of the Amer- ican Medical Association, has furnished" a complete copy of his statement to the Delaney Committee." The Council on Pharmacy and Chemistry and the Council on Foods and Nutrition unequivocally state: "After considering the evidence available at this time, the Councils believe that the use of drinking water con- taining up to one part per million is safe." The rea- sons given for avoiding additional intake of substances of high fluorine content and the wisdom of varying 12 the seasonal concentration of fluoride ion in the water, according to the climatic conditions, will be familiar to the reader. The Councils quite properly limited their statement to consideration of the health hazard. That they refrained from urging communities to sup- port or oppose fluoridation is simply recognition of the fact that the evaluation of the need for fluoridation in a given community and the assurance of the benefit to be expected from such a local program can best be made by members of the dental profession. Any group of physicians would be presumptuous in setting themselves up as better judges of the latter points than the dentists of the community and of the various Health Services. The House of Delegates has followed a similar viewpoint but endorsed the principle of flu- oridation as a forceful statement of their belief in its safety and effectiveness. Many opponents of the fluoridation of water sup- plies have recognized the merit of a daily intake of fluorine in approximately 1 mg. dosage to increase the resistance of the teeth to caries, provided that an- other means of ingestion be provided. Such alterna- tives suffer from either the risk inherent in dispen- sing necessarily concentrated stock solutions or the uncertainty, of dosage through bread, milk, salt or other foodstuffs whose intake by the individual varies much more widely than does the total intake of water (including the water in solid food). The expense and the distribution problems involved in the dispen- sing of tablets make them an impracticable choice also as a vehicle of preventive medicine. An elaborationGe of. the relative unsuitability of all these methods has been furnished by Robert E. Shank, M.D., Professor of Preventive Medicine and Public Health, Washing- ton University School of Medicine, St. Louis, Missouri. Topical application of relatively concentrated solutions of fluorides (directly to the teeth) have proven to be of definite value as a measure of individual pro- phylaxis against tooth decay. It is widely held to be less effective than systemic intake of fluoridated water from birth. The limited dental personnel available in both public health work and in private practice and the expense of such a method make it a poor choice of methods of prophylaxis in comparison with flu- oridation of a community water supply. It is wholly impracticable as a public health measure, therefore, in any but the small communities or in rural areas. One of the major, secondary benefits to be derived eventually from a fluoridation program is the partial release of dental personnel from the treatment of caries and its complications in order that they may devote more time to oral (mouth) prophylaxis and other phases of dentistry. It is outside the scope of this report to present the evidence for the effectiveness of fluoridation in those communities in which the concentration of fluorine ion in the water supply was formerly less than ideal. This is the prerogative of those members of the dental and public health professions who have made a lengthy study of the accumulated data. Suf- fice it to say that we have reviewed many published studies and have been furnished current, as yet un- published statistics from certain communities which give impressive testimony as to its merit. The close correlaton between endemic (natural) fluoride ion concentration of a community water supply in inverse relationship to the incidence of dental caries at a given age level is a marvel of statistical acceptability. The clarification of this relationship by Dean" and WATER FLUORIDATION others followed from earlier demonstrations" that dis- figuring brownish mottling of the enamel was due invariably to a high fluorine content of water and that where mottling (dental fluorosis) was common, caries was relatively uncommon. These fundamental observa- tions are a brilliant chapter in American science. Naturally enough, the first practical applications to which they were put were the development of means for removal of excessive fluorine from the water. Such programs of defluoridation were in operation for years before sufficient data had been gathered to per- mit the safe beginning of programs to supplement waters naturally deficient in fluorine. It is of particular significance that the people of the city 'of-Muskegon, Michigan (which had only a trace of fluorine in its water and was "teamed" with Grand Rapids for continuing comparison upon the initiation of fluorida- tion in the latter city in 1945) have become so im- pressed with the reduction of dental caries in the children of Grand Rapids that they have ceased to provide a base -line for comparison by initiating the fluoridation of the Muskegon water" The greatest benefits are seen in those persons who have received an adequate daily amount of fluorine from birth and this benefit. has been clearly demonstrated to extend in such persons into adult life, as shown by compar- ative dental studies" of adults up to the' age of 44 liv- ing in Colorado Springs (2.5 ppm) and those living in Boulder, Colorado which has practically no fluorine in its natural water supply. All of the residents raised in a community with an adequate concentration of fluorine will be benefited thereby in time, not merely the school children. It is not widely enough appre- ciated, however, that the benefit in reduction of caries from initiation of a fluoridation program in a given community will be proportionate to the concentration of fluoride ion at the outlets of the water system prior to the start of the operation. The city with a natural concentration of 0.5 ppm, for example can expect de- cidely less reduction of caries experience than one with only a trace of fluorine for the people of the former will have the lower incidence of caries prior to fluoridation. The need for increasing the concentra- tion of fluoride in the water supplies of metropolitan St. Louis has been strongly stated, the entire issue of the Bulletin of the St. Louis Dental Society, April, 1953, having been devoted to papers and communica- tions on the subject of fluoridation. Collected data reported elsewhere" show that the children of this community have an experience of. caries somewhat below the level anticipated from the average fluoride ion concentration of approximately 0.3 ppm and more nearly that to be expected from a water supply con- taining 0.5 ppm. This is not necessarily of importance; it may be interpreted as being due either to conserva- tive evaluation of observed caries or to the existence of climatic conditions (higher temperature and humid- ity) in the Mississippi Valley of a more tropical na- ture then we generally assume. Tool many other nutritional and oral factors enter into caries incidence to permit a specific explanation of this point. It must be taken into account, however, in considering to what concentration fluoride, supplement should be added to the municipal water supply and in attempt- ing a prediction of what reduction of caries incidence is to be anticipated thereby.. As has been stressed, the ideal concentration of fluorine to be approximated for any community must be arrived at by consideration of its climatic character- 13 istics and a lower concentration supplied in seasons of considerable warmth and humidity; there is new evidence " that dental fluorosis occurs at lower con- centrations of fluorine where such weather is pro- longed than in more temperate areas. With such a reservation as to actual concentration to be attained, we strongly endorse the Statement on March 1, 1951, by the Health Commissioner of St. Louis, J. Earl Smith, M.D., stating the official position of the St. Louis .Health Division and recommending the fluorida- tion of the St. Louis water supply. Dr. Smith has done well to point out that "Fluoridation does not eliminate tooth decay entirely ... Fluoridation is not a cure -all; good dental care will continue to be a necessity. Fluoridation is a preventive measure but is not 100 per cent effective. It is. no more a substitute for good dental care than pasteurization is a substitute for the clean production of milk. It is, however, a long stride forward in the fight on man's most com- mon defect, tooth decay." As citizens, as well as physicians, we should be mindful that no evidence of harm to any industrial process from the use of water containing as little as 1 ppm of fluoride has been published. On the con- trary, there is much testimony, based upon investiga- tion in their own laboratories, that the products of bakers;' canners' and brewers04 will suffer no del- eterious effect. The fears recently expressed' by G. S. Bratton, Technical Adviser to the President, Anheuser Busch, Inc. of St. Louis, fall into two cat- egories, 1) that the making of beer itself may suffer through effects on the yeast (contrary.to the evidence cited) and 2) that the increased concentration of fluoride through such processes as produce by -prod- ucts (which are used in other foods) will exceed permissible limits (approximately 5 ppm), Bratton has been answered, step by step, by W. Victor Weir, President, The St. Louis County Water Co., in an address' which should be studied by anyone inter- ested in this phase of the effects of fluoridation. Re- prints are obtainable from his office. None of the national distributors of beer has openly opposed flu- oridation of their community water supplies but it so happens that none of them is located in a com- munity which has, as yet, initiated fluoridation of its water except Milwaukee which initiated fluorida- tion July 1953. We have every confidence that mem- bers of the brewing industry will not in the future offer either open or overt opposition to a program of preventive medicine that is so demonstrably in the public interest. The reader must realize that the breweries of Milwaukee used water from deep wells containing an average of 0.9 ppm (one as high as 1.8 ppm) of fluoride ion from the year 1879. In more recent years, many breweries established private filtration plants for the use of Lake Michigan water, but now use the municipal water supply which con- tains only a trace of fluorine. As for other points of interest, fluorides at the specified concentration have no bactericidal (germ - killing) effect, do not affect the compounds formed in water after chlorination and provide all or part of the fluorine needed to remove silica from boiler water, depending upon which com- pound is used. There have been no effects on sewage treatment processes, the fluoride concentration of sew- age quickly reaching that of the water supply." As of August 1, 1953, the following major cities in the United States are fluoridating their water sup- plies: Baltimore, Md., Washington, D. C., Pittsburgh, WATER FLUORIDATION Pa., Cincinnati, O., San Francisco and San Diego, Calif., Tulsa, Okla., Louisville, Ky., Indianapolis, Ind., and Milwaukee, Wisc. Philadelphia, Pa. has authorized fluoridation. Together with the more than 700 other communities in 43 states, a total population of more than 14,000,000, are using water supplemented with fluorine. Missouri is one of the five states in which no fluoriation is being practiced, the others being Arizona, Nevada, New Mexico and Utah. Exhibit 1. Stability of an Element The fundamental premise upon which the science of chemistry is based is that of the uniformity of identity of any element. For instance, all sodium ions with an atomic weight of 23 are identical in properties, no matter what their source. The atomic weight deter- mines 'the structure of the atom and informs the chemist of the element's characteristic properties and reactions. Ephraim states, The atomic nucleus ... (is) an extremely stable system! Along with all other chemists, Professors S. S. Cooper and C. N. Jordan of the St. Louis University Department of Chemistry stated recently that Fluoride ion from one source is identical with Fluoride ion from all other sources E. A. Do1sY, JR., M.D. 1. Ephraim, F. Inorganic Chemistry. Nordeman Publishing Co., Inc., New York, Ed. 4, 1943, p. 9. 2. Personal Communication. Editorial Note: Due to lack of space, only Exhibit 1 is reproduced. Exhibits 2 to 21 are on file at the St. Louis Medical Society and are available for inspection. The Committee was appointed by Dr. A. N. Arneson, M.D., President, on January 30, 1953. Members of the Committee: Harold A. Bulger, M.D.. Assistant Professor of Clinical Med- icine, Washington University School of Medicine. Raymond O. Muether, M.D., Associate Professor of Internal Medicine, St. Louis University School of Medicine, and Director of Laboratories, St. Mary's Group of Hospitals. Willard Bartlett, M.D., Chairman, Assistant Professor of Clinical Surgery, St. Louis University School of Medicine. Consultants of the Committee: Edward A. Doisy, Jr.. M.D., Assistant Professor of Internal Medicine, St. Louis University School of Medicine. Robert E. Shank, M.D.,. Professor of Preventive Medicine and Head of Preventive Medicine and Public Health; Pro- fessor of Preventive Medicine in Department of Medicine, Washington University School of Medicine. J. Earl Smith, M.D., Senior Instructor in Internal Med- icine, St. Louis University School of Medicine, and Health Commissioner, The City of St. Louis. BIBLIOGRAPHY 1. Statement by E. A. Doisy, Jr., M.D., received July 11, 1953. (Exhibit 1) 2. McClure, F. J., et al.: J. Indust. Hyg. & Toxicol. 27:159- 170 (June) 1945. 3. Machle, W., and Largent, E. J.: J. Indust. Hyg. & Toxicol. 25:112 (March) 1943. 4. Heyroth, F. F.: Am. J. Pub. Health 42:1568 -1575 (De- cember) 1952. 5. U. S. Public Health Reports 61:371, 1946. 6. Dean, H. T.: Dentistry in Public Health, p. 136, Phil- adelphia, W. B. Saunders Co., 1946. 7. Report of ad hoc Committee, National Research Coun- cil, p. 3, November 29. 1951. 8. Cox, G. J., and Hodge, H. C.: J. Am. Dent. A. 40:440- 451 (April) 1950. 9. Dean, H. T.: J. Am. Water Works A. 43:17 -21. 1951. 10. Arnold, F. A.: J. Am. Dent. A. 50:499 -508. 1943. 11. Hearings before the House Select Committee, etc., House Rep. 82 Congress. 2nd session. Pursuant to House Res. 74 and House Res. 447, Part 3, 1952, p. 1655 -p. 1769. 12. Hill, I. N.; Jelinek, O. E., and Blayney, J. R.: J. Dent. Res. 28:398 -414 (August) 1949. 13. Schesinger, E. R.: Overton, D. E., and Chase. H. C.: Ain. J. Pub. Health 40:725 (June) 1950. 14. N. Y. State Dept. of Health Bull. 5: August 13, 1952. 15. Personal communication from W. H. Tucker, M.D., dated March 9, 1953. (Exhibit 2) 16. McClure, F. J.: U. S. Pub. Health Reports 59:1511, 1944. 17. Grodowitz, W.: Cancer Morbidity, Series 2, 1951. Fed- eral Security Agency, U. S. Public Health Service. 18. Mercus, S. C.: Cancer Morbidity, Series 4, 1951. Fed- eral Security Agency. U. S. Public Health Service. 19. Forsyth, B. D.: House Rep. 82nd Congress, 2nd session, loc. cit. p. 1636. 20. Sommers, H. J.: U. S. Public Health Reports 57:1566, 1942. 21. Sommers, H. J.: Ibid. p. 1971. 22. Wisconsin State Board of Health, continuous resident data, 1951. 23. Personal communication from G. J. Hildebrand, M.D., dated February 26, 1953. (Exhibit 3) 24. Personal communication from W. B. Prothro, M.D., dated February 27, 1953. (Exhibit 4) 25. Personal communication from C. V. Tossy, D.D.S., dated May 14, 1953. (Exhibit 5) 26. Personal communication from Fred D. Welch, M.D., dated March 5, 1953. (Exhibit 6) 27. Form letter to presidents of 15 local medical societies. (Exhibit 7) 28. Form letter to 15 District Health Officers. (Exhibit 8) 29. Personal communications from presidents of local medical societies and from District Health Officers in eight other cities. (Exhibit 9) 30. Fluoridation of Water Supplies, Iowa State Dept. of Health, 1951. 31. Hodges, P. C.. et al.: J.A.M.A. 117:1938, 1941. 32. Brun, G. C.; Buchwalk, H., and Roholm, K.: Acta. Med. Scandinay. 106:261, 1941. 33. Largent, E. J.; Bovard, P. G., and Heyroth, F. F.: Am. J. Roentgenol. 65:42 (January) 1951. 34. Largent, E. J.: Arch. Ind. Hyg. & Occup. Med. 6:37 (January) 1952. 35. Roholm, K.: quoted by Heyroth, F. F.: Am. J. Pub. Health 42:1568 (December) 1952. 36. Largent, E. J.: quoted by Heyroth, F. F.: Am. J. Pub. Health 42:1568 (December) 1952. 37. Greenwood, D. A., et al.: J. Dent. Res. 25:311 (Octo- ber) 1946. 38. Jackson, S. H., et al.: J. Nutrition 40:515 -535 (April) 1950. 39. Black, M. M.; Kleiner, I. S., and Bolker, H.: New York J. Med. 49:1187 (May 15) 1949. 40. Tearsheet from a pamphlet entitled "Fluoridation," by H. B. Anderson, Secretary, Citizens' Medical Reference Bureau, price 10c. (Exhibit 10) 41. Copy of address by Gerald J. Cox, Ph.D.. delivered June 20, 1952. (Exhibit 11) 42. Letter from Robert S. Harris, dated Jan. 20, 1953. (Exhibit 12) 43. Hurme, V. O., Dental Items of Interest, 74:518 -534, June, 1952. 44. Taylor. Edward, Texas Dent. J., 69:381, September, 1951. (Exhibit 13) 45. Copy of a letter from Chauncey Leake, dated October 1, 1951. (Exhibit 14) 46. Copy of a letter from W. B. Prothro, M.D., dated June 2, 1952. (Exhibit 15) 47. Doty, J. R., and Phair, W. P.: J. Am. Dent. A. 45:351 -356 (September) 1952. 48. Williams, H.: Baltimore Health News 29:42 (August) 1952. 49. Letter from E. V. McCollum, dated January 6. 1953. (Exhibit 16) Published in The Bulletin, St. Louis Dental Society, 24:22 (February) 1953. 50. Reprint from Prevention, A Magazine Devoted to the Conservation of Human Health. (July) 1952. (Exhibit. 17) 51. Excerpts from Americanism Bulletin, No. 17, (Sept.) 1951. (Exhibit 18) 52. Report of the Select Committee, etc., House of Rep. 82nd Congress, 2nd session, pursuant to H. Res 74, 82nd Congress, 1st session, (July 10) 1952. 53. Doty, J. R., and Phair, W. P.: J. Am. Dent. A. 45:351- 356 (September) 1952. 54. Personal Communication from George F. Lull, M.D. (Exhibit 19) 55. Statement submitted on February 27, 1952 to House Select Committee on behalf of American Medical Assn. by George F. Lull. (Exhibit 20) 56. Statement by R. E. Shank, M.D., dated June 27, 1953. (Exhibit 21) 57. Dean, H. T., et al.: J. Am. Water Works A. 35:1161, 1943. 58. McKay, F. S.: J. Am. Dent. A. 15:1429 (August) 1928. 59. Russell, A. L., and Elvove, E.: Pub. Health Reports 66:1389 -1401, 1951. 60. Report of the Mayor's Committee on Water Fluorida- tion, St. Louis, Missouri. 1953, E. E. Nelson, M.D., Chairman. 61. Galagan, D. J., and Lamson, G. G., Pub. Health Re- ports 6S:497 -507 (May) 1953. 62. Faulstich, C. B.: Am. Institute Baking Bull. No. 66 (July 6) 1950. 63. Greenleaf, C. A.: National Canners A. Res. Rep. No. 6 -51 (June) 1951. 64. Slater, R. R.: Proc. Am. Soc. Brewing Chemists, p..60, 1951. 65. Bratton, G. S.: J. Am. Water Works A. 45:364 -368 (April) 1953. 66. Weir, W. V.: J. Am. Water Works A. 45:369 -375 (April) 1953. 67. Maier, F. J.: J. Am. Water Works A. 42:1120 -1132 (December) 1950. 14 April 22nd, 1953- ` 1.7r.- Robert ' F. White,,, 5114 Arden Avenue, Minneapolis 10, Minna Re: Addition of Fluoride to Water System,- Dear Mr. 'White= , Thank you'for your letter of Fabruary•lgth regarding the above matter: We are-interested in this matter-and are studying it at the-present time to see whether or .not it 'should be adopted by the Village of Edina: ' .Yours very truly, S. R. Mitchell, Village Manager. 4 - j MEMBERS PRINCIPAL STOCK AND T COMMODIY EXCHANGES R.C. MEES RESIDENT PARTNER PAINE, WEBBER, JACKSON & CURTIS ESTABLISHED 1879 PILLSBURY BUILDING TELEPHONE MINNEAPOLIS 2. MINN. AT- LANTIC 3841 February 18, 1953 Mr. Sidney R. Mitchell Edina Village Office 4801 W. 50th St. Minneapolis, Minnesota Dear Mr. Mitchell: D. M. WARNER RESIDENT PARTNER It is my understanding that the Village of Edina has studied the addition of fluoride to its water system and is currently waiting to see what action, if any., Minneapolis will take on this matter, before it acts. Fluoridation, in Minneapolis, has become a political football and it will' be sometilr>;e�:lbe- fore the city makes a decision. In view of the fact, the Minneapolis City Council will be cut from 26 to 13 members in the next election, there has been a reluctance on the part of council members to vote for anything pro- tested even slightly. Such protests have come primarily from those without knowledge. There is overwhelming evidence in favor of fluoride supported by majority opinion of the dental and medical profession. The greatest support has come from doctors who have studied the question, and not necessarily from the average practising doctor or dentist who has mere knowledge by virtue of medical journals. Fluorides are now being used in the water systems of Baltimore, Pittsburgh, Washington, D, C., San Francisco, and was instituted in St. Paul in Sept -, ember 19[2. Furthermore, 27 communities in.Minnesota, including Austin and Fergus Falls, are using fluorides. Considerable material may be obtained from the office of Dr. William A. Jordan, Director of Dental Health with the State Health Department. It is my suggestion the Village pursue its studies further and take positive action,, <,: rather than wait for Minneapolis" decision. If economically feasible, I strongly favor the addition of fluorides to Edina. water,,.` :°Yours. very truly Robert F. White 5114 Arden -,Ave. RF6d :mw Minneapolis, Minn. VILLAGE OF EDINA 4801 WEST FIFTIETH STREET • EDINA, MINNESOTA March 19, 1952 RE: FLUORIDATION OF VILLAGE WATER SUPPLY At the present time there are no meters on the well pumps to show how much water we are pumping. For our own good, these meters should be installed, as the only way that the effi- ciency of the pump can be determined is by amount of water pumped per K.W.H. of current used. The cost of installing this metering equipment for 4 Recording Flowmeters ® $364.12 4 Venturi Tubes @ $700.00 Installation @ $500.00 TOTAL - BRISTOL EQUIPMENT or 4 Mechanical Receivers ® $640.00 4 Venturi Tubes ® $530.00 Installation @ $500.00 TOTAL - BUILDING- PROVIDENCE EQUIPMENT four wells would ber- #1,456.48 $2,809.00 $2.000.,00 6,256.48 $2,560.00 $2,120.00 $2,000.00 66,680,00 The installation-cost is high because of the short piping space in the pump houses. The Venturi Tubes will have to be installed in the lines outside the pumphouses, and manholes built. With regard to fluoridation, this will require fluoridation at each well. By using a liquid injector we will only have to add room to the small pumphouse at 50th and Wooddale. Using dry feeders we would have to add extra room at the two pumphouses at Wooddale and at the Southview Lane pumphouse. The cost of four liquid injectors would be about $2,500; the dry feeders would be about $5,000e The cost of liquid feeding is higher, as it would be $3,40 per million gallons treated, as against $1.05 per million gallons treated, for dry feeding. Liqumd injectors use a small motor consuming about 50 Watts, against a 3 to 4 H.P. motor which a dry feeder uses. This There are more companies making hydrofluosilicic acid than when first used, which I believe will tend to reduce the cost of this chemical so that the difference between it and sodium silico fluoride will be less in the future. Most of the small systems with well water supply from widely separated wells are using the liquid type fluoridation. The total cost of fluoridation to our system would be approximately $6,250 for metering equipment, plus the cost of injectors, $2,500, and pumphouse work, $700, or a total of about #9,450. My suggestion on this would be to meter two pumps this year, then next year meter the other two pumps; or, to do all the metering this year and add fluoridating equipment next year. This equipment will, I believe, be compacted and improved very fast, as it is still new. With all the study and work being done on it, there should be much improvement. BEN WOEHLER, SUPT: PUBLIC UTILITIES BW:gsa March 19, 1952 - TO: MR. HITCHELL 8E: FLUORIDATION OF VILLAGE TIATER SUPPLY At the present time there are no meters on the well pumps to show how much water we are pumping. For our own good, these meters should be installed, as the only way that the effigy ciency of the pump can be determined is by amount of water pumped per N.W.H. of current used. The cost of installing this metering equipment for four wells would be: 4 Recording Flowmeters o $364.12 $1,456.48 4 Venturi Tubes 0 8700.00 $)2,800.00 Its tailation 0 $ 500.00 000.00 TOTAL - BRISTOL MUIPMW $6,259.48 or 4 Mechanical Receivers Q $640.00 $2,,560.00 4 Venturi Tubes 00530-00 X20120.00 Installation 0 $500.00 $2.000.00 TOTAL - BUILDINGS- PROVIDITICE EQUIPWNT 4 6, W. 00 The installation cost is high because of the short piping space in the pump houses. The Venturi Tubes will have to be installed in the lines outside the pumphouses, and manholes built. With regard to fluoridation, this will require fluoridation at each well. By using a liquid injector we will only have to add room to the small pumphouse at 50th and Wooddale. Using dry feeders we would have to add extra room at the two pumphouses at 1-- boddale and at the Southview Lane pumphouse. The cost of four liquid injectors would be about X2,500; the dry feeders would be about $5,000. The coat of liquid feeding is higher, as it would be 43.40 per million gallons treated, as against $1.05 per million gallons treated, for dry feeding. Liqu&d injectors use a small motor consuming about 50 Watts, against a 3 to 4 H.P. motor which a dry feeder uses. This There are more companies Snaking hydrofluosilicic acid than when first used, which I believe will tend to reduce the cost of this chemical so that the difference between it and sodium silico fluoride will be less in the future. Most of the small systems with well water supply from widely separated wells are using the liquid type fluoridation. The total cost of fluoridation to our system would be approximately $1,6,250 for metering equipment, plus the cost of injectors, $2,500, and pumphouse work, $700, or a total of about $9,450. W suggestion on this would be to meter two pumps this year, then next year meter the other two pumps; or, to do all the metering this year and add fluoridating equipment next year. This equipment will, I believe, be compacted and Improved very fast, as it is still new. With all the study and work being done on it, there should be much improvement. ft gsa BRI rmmBR, SUPT s PUBLIC UTIL3^t YE�3` March 19, 1952, TO: MR. MCHELL RE: FLUORIDATION OF VILLAGE t'1ATal . UPPLX At the present time there are no meters on the well pumps to show how =ach water we are pumping. For our own good, these meters should be installed, as the only Wev that the effi- ciency of the pump can be determined is by amount of water pumped per H.lf.H. of current used. The cost of installing this metering equipment for four wells would be: 4 Recording Floameters 0 $364.12 Us,456.48 4 Venturi'Tubes 0 0700.00 02,800.00 Installation C 0500.00 W.000.00 TOTAL " BRISTOL OL HQUrFWWT 66s256.48 EOFIA 4 Mechanical Receivers () 3640.00 �2s 560.00 4 Venturi Tubes 0 1530.00 �2s12%00 Installation 000.00 $2.000.00 TOTAL - BU ILUING- P80VIAIZ7C ,E-UIt WM v The installation cost is high because of the short piping space in the pump houses. 'The Venturi Tubs will have to be installed in the lines outside the pumphouses, and manholes built. With regard to fluoridation, this will require fluoridation at each well. By using a liquid injector we will only have to add room to the small pumphouse at 50th and Wooddale. Using dry feeders we would have to add extra rerun at the two pumphouses at T:ooddale and at the 9duthview Lane pumphouse. The coat of four liquid injectors would be about 12,$00; the dry feeders would be about �%0d0. The cost of liquid feeding is higher, as it would be 43.40 per million gallona treated, as against 11.05 per million gallons treated, for dry feeding. Liqu&d injectors use a small motor consuming about 50 Matta, against a 3 to 4 H.P. motor which a dry feeder uses. This There are more companies making hydrofluosililcio acid than when first used, which I believe will tend to reduce the cost of this chemical so.that the difference between it and sodium silico fluoride will be lease in the future. Most of the mmll systems with well water supply from snidely separated wells are using the liquid type fluoridation. The total cost of fluoridation to our system would be approximately 0,6,250 for :metering equipment, plus the cost of injectors, 02,500, and pumphouse work, 4700* or a total of about $9,450. . My suggestion on this would be to meter two pumps this year, then next year meter the other two pumpa; or, to do all the metering this year and add fluoridating equipment next year* This equipment will, I believe, be compacted and.improved very fasts as it is still news with all the study and work being done on it, there should be much improvement. sir '73TR, SHPT; PUBLIC UTIL=Z' 8!1: gsa March 19, 193 TOs M, HITCH UL R& FLUGMATION OF VUIA03 VAT ;;UFPLX At the present time there are no notes on the well pub to shave hens mach mstor we am puaaping. Vor our ®ern good, these meters should be Installed, as the only that the offi- eiency of taw pump can be determined is by remount of Mater pupped per K.it.H. of current used. The cost of installing this metering equipa►ent for four wells would bes wm 4 Recording ploaters 0 X964.12 b'1,4Sf .hg 4 Venturi Tubes 0 8700.610 Installation 01 05W-00 $2.000.00 TOTAL - S"TOL 10WIM, XT 66s256.48 M, 4 Mechanical Rowdy ers► () WA0.00 US $0.00 4 Venturi Tubes 0 W0.t10 42,1 1.00 Installation 0 OW.00 $2.000.00 TOTAL +- BU 1WVW- PWV1DaiCB, SUIPWi 1'1` , .00 The insteslhation cost is high because of the ohort piping spa** in the pimp houses. The Venturi Tubes will have to be installed in the lines outside the pumphousesa, and manholes built. With regard to fluoridation s. this will require fluoridation at each erello By using a liquid injector we will only have to add goon to %he sma11 pumphause at 50th and Wooddale. Using dry feeders we would have to add extra room at the too pumphouses at t:ooddale and at the 3outhview )Hans pumphouss. The cost of tour liquid Injectors would be about .12,500; the dry feedon Would be about 95,x• The cost of liquid feeding is hiehor, as It would be 3.40 per million. gallons treated, as against 4,11.05 per cdUion gallons treated, for dry feeding. LigO4 Injectors use a amall motor consuming about 50 gaffe, against a 3 to 4 H.p, motor which a dry feeder uses. Thin There are more companies making hydrofluosiliaia acid than when first used, which I believe will tend to reduce ti* coat of this chemical so that the difference between It and sodium silloo fluoride will be lean In taco future. Most of the small systeaes with wall water supply` from widely separated wells are using the limed tppe fluoridation. The total cost of fluoridation to our system would be approximately C -6,2$0 for motoring equlyment, plus the cost of Injectors, 2,5OO, mid pueaphouae work, 07W, or a toted of about ►9,450. W suggestion on this would be to meter two pumps this year, than next year meter the other two pumps; ©r, to do all the metering this year and add fluoridating equipment next year. Tbis oqu$pment will, I ballove, be compacted and Improved verb fast, as it is still new. With all the studio and amok .being done on It, there should be much improvement. SUPTs M- LIC UT1 r, ails Beta March 19, 9952 RRt PTl#OBIDATY0U OF VILLAGE -TAT LI FPM At the praesemt, time there are no metere on the well pau+OS to show how much water we are pumping. For our own podp these motors should be insulled, as the only way that the sffl - aUse r of the pump am be det+emined Io by amount of water pusped, par, gelf.H. of current used. The cost of installing. this metering ecafpneat- for Four wslla would bet 4 Recording Plawastero 0 $364,12 (1,456.48 4 Venturi Tubes V $700.00 b20800.00 Iratellatiorn o $500.00 0 0 TOTAL - :i1% B. UW —t- «'T jt�rrri .4 T 4 Rechudeal Receive rer 4 Venturi Tubas 0 030.W ��p ,00 inetallatdon X50@.00 00 TOTAL - SU - PWUDWGS W�UV W 4 ,680.00 The installation cost is high because of the short pipUW space in the puree houses. The Venturi Wbos will have to be installed in the Lines outside the pumphousesp and ms{nholes buflt• Witb regard to fluorldatioxap this will require fluoridation at each welt. E{y using a liquid injector we will on]y hm to add room to the cull pumphouss, at 50th and WdoWele. Using dry feeders we would have to add extra rom at the two pumphousess at 1,00ddale and at. the Southview Lane pumphouse. The cost of four liquid injectors mould be about UpW; the dry feeders would be abut �$,Oi?O• The cost of liquid feeding is higher, an it would be x9.40 per minion gal. ons treated, to asainst 91.03 per million gallons treated., for dry feedI.Ag. Uqubd injectors use a wall motor consutsimg about 50 Watts, agaia3t a 9 to 4 H,Po motor which a dry feeder uses. This - There are morn oompaniesr making hydrofluosillaaie avid than when first used, which 1.. believe will tend to reduce the cost of tlAo chemical so thrat the difference between it and sodium siliao fluoride sill be leas In the future, Most of the sea 1l systems with well water ox4qALy f'ron widely :separated wells ate► us%g the liquid type f1wridetime The total, asst of l3uorldatlon to our system would he eapproximtolq 06,250 for motoring equipmentp plus the cost of injectorsp 02#5W. and pumphouas work, 0700, or a total of about $9,4500 Ry suggestion on this would be to actor two pumps this yam', then next year aster the other two ,tamps; or, to do all the metering this ,yftr and add fluoridating equipment next yems'• Phis equipment w111, 1 believe, be coMmeted and Improved very fast, an it Is still new. With all the stu4y and wank . being done on it, there ahould be such improvement. Um_��, SUM PUB110 UTIMI' .'a 8Wogsa March 191, 1952 TOss Ham, MITCML At the preaout tine there ors no **ton on the well pnos, to show how much vator we are peseping. For our o-,m goad, these asters ohould bee ihstalled, cue the ot>.r rinse that the efa- e lonay of the pump an be dotontin d is by ammunt of water pwoped per KeW,H, of current used. The cost of installing third aetssering equipse[aent for 4 Asoordb% nman esst►ers 0 $3 4*U 4 V entuarl Tuba f MOOD tael.3stlssaen �f $$W.00 TO r MiiSTOL 14E 'P or 4 Venturi Tubes; 0 0530-00 I"ta1lution P S50D.0D TNAL – aj�piwz=ws & vxm four ::swells would be' f1,45b.4Q ,a 48 $2850,00 02sl 1.00 0-06W--*-W Tho Installation cost, is because of the obort pipU% apace In the pump houses. the Vmturi Tubes will had to be Wiled in the lines outside the puvph uoes&,$ and usaho% built. Ulth regard to fluor1dat1ose, this will reequire fluoridation at each a*U* By using a 13guid Injostor we will only hwro to add row to the - small pupWhousres! ut 50th and - WooMale. UsiftS dry feeders we wa ild hsssve to add extra rook at thu two pmphouses at ':ooddale and set the Soutiht ow taane pumphouse. The coat of four liquid Injectors would be about $2,1500; the dry feeders would be about 05,ov0. Tba coat of liquid feeding is hioftes<r, as it ww14 be 43.40 per million g1.%onsa treated, asr against $1.05 per million gas►l.laxir treated., for +dx7 feeding. UqW injectors use a< small motor conmuftg about 30 'Val-too against a 3 is 4 R.P. rotor xbich A dry feeder uses, Thie - There are more omqAn3.es+sss creaking hdrof1uos1U*1c said than when first used, which l bellove will tend to reduce the oust of thlo chemical so that the diftoresesuae between it and sodisae ollieto tluvAds will be less In the futuroo Most of the swill ssysstea o with weell water supAs frm widely se mr4tod wells, are timing the liquid tirps tluorldntion. The total :east of Moridation to our eptewt would be approxiustely 16#22 fo r uttering equip sooty plus the cost of Weeeterse, 02#5000, asrA pmphmase work, 4700, or a total of about $9,451D. suggestion on this: would bee to meter two pub this year, then next year aeftor the otter, two pumpsi or, to de all the motoring this year si d add fluarldating opipsnent text yr. Thin 1peeont will, l beelievo, be 4=paoW and 1"roved ver7 fast, arse it is still now. With 41 the study and waft being donne on Its thero abould be such Improvemento Ort 143141=9 awn p9. 1, ° 1 8 z _ I --4 - - - -. -- — — IJ 1 _ x S L• I!I ill III ROAD 0 A O - I C O U N T y ND 1 8 C O U N T Y D - r L2 SLr._J L z _' •• °, 1O ' WIUARIS Sub. T DuEES Sud GRI FF 1$511D. • - - CF RLOCN 31 Op BL 2 � I 1`J RO 4 �9 �- - - - - -- z > x kFWT '�' [_ I • K E < C�D OLI.NGER ROAD I D I r Ir 4 I z lb ° z ' n � . a♦. 4 - = flu ♦ f � ... C w x - 1 a -jl y AND u. T_ H E r . > I 4 H A N S� E I N I E L D I w I I I - • � I E I 4 r 6� L I N E 3 alr 'u e• �+' nu ...r ~ v �; RIELENc H I G H W A Y - W E S T _ ° •z 'I ^ -- f'n DROOk51DE _ E I _ o u• v — B E L T 1 I 1 _ r_ \ 1 sJ ° o k O 1'�I 1•-I � r nc - v W O D D A L E L�J M A V E N U E a - - - -- — i ..ro... :... - .�....� . y -- . ............ DALE r £Q, 3 t . p I �� i c . S.. �• �. ., . �. a 1. ' n ,. I _ A i v . -- 1 � O• � .» 1 R S --.- C R A \ E N \Y " b•, A V E N �u D.'OR J8 ys Igo �Mt - - -- - - -- J E T \� ... ... > .. l F R A N C E A V E N U EJ E'D'FIA JMA O-R - R O A D w 1 r A - - AIL-- -`�`�'•. ' a / > �z o 3 y , O ' "�,�` �� A z L YORK a TERRA E m31 N ° 4 a' . � .. Oo,-E.- ----j x o F + J_ _ M. .w cY fi n I O R t � D n y > D < [F; N J �rl 7 i 0 O M f > m :U1 n+F+ 4 O Z � r O N P, R O A D w 1 r A - - AIL-- -`�`�'•. ' a / > �z o 3 y , O ' "�,�` �� A z L YORK a TERRA E m31 N ° 4 a' . � .. Oo,-E.- ----j x o F + J_ _ M. .w cY fi n I O R t � D n y > D < [F; N J �rl 7 i 0 O M f > m :U1 n+F+ 4 O Z � r O a10 .0 .i Flu�r� Itrdduce,d ordinance calling °for add - " fluorides to city water; and �z cluding:proportionate costs on individual' water' bills. was. intro - } duced at ` today's city council t meeting by ' Aiderman 13yron F. Nelson. -The measure was referred to the council water .works commit - tee. for- study. Meanwhile. - the state health ~ department announced that sev -; en Minnesota communities -now, a adding - fluorides to wate^Y They\are Red Lake Fa1JF, first o mtr uce the plan_- nd Wi_•i- ago= West ,C .icord, Thief Ri 1-- ,rracr`Wontevideo,,Fergus Falls and Fairmont: Other communities which have ordered necessary equip- ment- are St. Paul, Arlington, Perham, Ely, Austin, Granite Falls, Hallock, Benson, Hutch- inson; Mapleton, Morirs, _ Clo- quet.and Mora. Dr. 'W. A. Jordan, director of the department's dental health program; said "there is no dan- ger from use of fluoridated .wa- ter. if approved 'equipment is used and health department rec j omInendations regarding its use arye carried out." j Fluorides in-water have great- es value. for ,youngsters while 1 their '.teeth are developing; from birth to .the age of eight years, he said: —_ - J r7 c sac 7 v Q� Ile 4vr; ylZe- �/� - �h� 1, �C�G� /Di1 ��Y��� ��� �/�i��✓ ®/� r� /3 11C7 O1 /� D a5�/% o ,s�iq� c e 07' 0/' �lGi� e �- /�� ms�� d AKe 4Yd -f o� ¢/Se ���f �� ��c/`es� l9 .`yy/�c� is �/a e G���� r�•� � J r7 Q� cep' o ��a •-� �e,-��a 7 L- / / s !/e Tf //-1 . //>IE/'-r crc,%`!d� G,,,.c J119 r�ccs�a i-�v llti1 - -�� Ot 2C1'cr/C -,e ��l�d -ocrall /r� 6I o e 45, � `C re4,o yGd dpor/; er aiel ec9/e;:7-c ar/o�� cp z o: /-- - 11C7 O1 T h e ed it®ria Page 10 Thursday, FE Let the people have the truth and the freedom to discuss it, and democracy will net Fluoridation o public, water to ny an 75 y su lies ,is safe, e ecti'm a to, "Fluoridation of water supplies is definitely' thousands of peopoe have been using water sup- Be in the public health picture to stay," says Dr. plies that naturally contain one ppm or more W. A. Jordon, director of the division of den- of fluoride, with . no . ill effects. tal health, Minnesota department of health. What effects may be expected from fluori- tional Because fluoridation has been talked about dation? floodi on more than one occasion by the Forest Lake We can expect to reduce dental caries �2. ex Jaycees, PTA and village council, the Times pre -. ( tooth decay) as much as 60 per cent in persons cents the following questions often asked re- who drink the fluoridated water continuously gar this new topic and Dr. Jordan s an- during the period when ,their teeth are form - swers. • Since the Times has reason to believe that mg (from birth #0 8 or 10 years of age). Cities now using fluoridated water in controlled 10- the village council will take no_ action toward fluoridation of the .Forest Lake municipal . . year studies report the expected amount of caries reduction for the five or six years that the ter supply of its own volition, interested com- studies have been under way. s munity leaders should work thru their ,various organizations toward this end, if they feel —af- Isn't fluoridation a_ kind of mass medica- ter giving it proper study —that it is a desirable tion? • . No. Fluoridation is. not recommended as O re ardi move. What is the State Health D artment. poi- a treatment or a cure. It simply prevents the initial development of dental decay. Fluorida- izat ion Th icy on the fluoridation of public water sup- plieg? tion simulates a condition that is set up by na- Forest The State Health Department approves of ture in communities fortunate enough to have add ve the addition of fluoride to public water sup- one ppm of fluoride naturally, present in the school plies in Minnesota, in amounts necessary to brin g the- concentration to the optimum level water supply. Is there any connection between fluoride intake In area no litt of one. part of fluoride to one million parts of This is by the Am- and cancer? No, such connection has even been shown, very has for water: approval endorsed encan Dental Association, the Minnesota State nor is there any evidence of any such relation - All Dental Association, the United States Public ship. The National Cancer Institute studied ral distri Health Service, the Minnesota Public Health cancer prevalence in ten cities. -It found that if not al Conference, and many other professional groups. a there was no greater prevalence of cancer in Lake as Is there dependable evidence that one cities where the fluoride content of the water' And ppm of fluoride in a public water supply is not was approximately one ppm than in those where well inde harmful? the water was substantially fluoride -free. Wendell Fluoride in a concentration of one ppm is What does fluoridation cost? county sc well below the toxic level. For many years, The cost varies from 4 to 14 cents per per -- the reorgf tions, I have appointed a commit - �� Hfamily arrives .urned i Farm there 'joins c ®I ®n y i ®P High under By Dale Hostvet and the largest European family The new Kauls were greeted at gave Without a doubt, the biggest of displaced persoff§ ever to come the depot Feb., 1 by the Teodors Star- and happiest "family" in three to Minnesota under the guidance Kauls Jr. and by•.Rey., L. K. An- a counties -15 persons! —are today of the Lutheran Welfare Society. derson of > Faith Lutheran church. gsters living in a little 5 -room home on Parents Arrive Tears of joy and gratitude filled i their Sixth avenue alike as they were again united enue in west Forest Lake. Little over a year later, Febru- the eyes of parents and children served The "overload" is of course tem- ary. of 1951,. the Kauls, who had with" loved ones, after an absence .ies at porary, but for the present two already become- self- supporting, `of several years. d and families of grateful Latvian dis- were joined by Mr. Kauls parents, . a big placed persons are having a joyous Mr. and Mrs. Teodors Kauls Sr., The Lutheran Welfare Society family reunion on the order of the and the family grew to 11. of, Minnesota provides the "vehic- every gold lady who lived in a shoe." However, =the elderly. couple le" _ through whom the assurances vement To begin this story' of the Kauls have since gone to live with a are sent across to displaced per - square —a name now well -known to For- daughter in Michigan, to help care sons in Germany. After very close set once est Lakeites —we must go back to for her 'two children while she is screening, and scrutiny, according of danc- a little over two years ago, Dec. employed. to Rev: Anderson;,both as to health 31, 1949. And thus, our "keeping up with as well as to political inclinations, the Kauls story must return to the people await the assurances of oes not It was then, on New Year's Eve, the figure of nine again. housing and work in America. a sched- that Mr. and Mrs. Teodors Kauls zt every- Jr. arrived in Forest Lake. under Last week however, exactly one Looking for Housing square the local sponsorship of the Nor- year to the day since the elderly Assurance for the Hermann Arnold ton Taylors. They were displaced couple had arrived, another Kauls , Kauls was provided by Mr. and.Mr. will act persons, from Germany and origi- son st his family came to live at George Koester of Forest Lake. Forest Lake. However,' they are living with the • nally -from their home land of. Lat::: _. _ ._ _ �. � g . he club via. The yHermann Kauls Teodors Kauls until tliey can.find - esday of With them came their six chil- The new arrivals . are Mr. -and suitable - housing. They have found Country dren: five boys, starting with Ted Mrs. Hermann Kauls and their an apartment 'in - Wyoming and in- t. Watch who is now an FLHS junior, and four children. Hermann. and- Te- 'tend to' move there soon. on down to Mara, the only girl, odors Jr. are brothers. The four The Hermann Kauls have not yet now 5. a children are, Vidor 16, Hermann had, opportune time to learn Eng- �� They were also joined by Mrs. Jr. 12, Lilliane 10, and Peter 6. i lish and to become as well- ac -. Kauls' mother, Mrs. Monson, to They joined their cousins in the quainted in this country as have make it a happy family of nine, Forest Lake classrooms Monday. ..the Teodors ' Kauls . in .their 25 Sr. months..here. Mr. Teodors Kauls SECOND SECTION — Pages 9 =16 is employed at U. S. Bedding com - pany in St. • Paul. , to be held So now there are 15: All in one house. Three bedrooms, a kitchen .g for Jo- and a livingroom. ' :din Hugo- But they'll tell you it's grand to 1 officiate see old, familiar faces. again, - es- church to pecially in a strange country: Just h burial in Forest Lake, Minnesota Thursday, February 14, 1952 as it grand to finally •take root in a new country —the United tonald and . - States —after years as refuges from and Dennie VFW fishh1g CRAPPIES, KITE the now Communist dominated homeland of Latvia. this Leroux. p�Y Saturday Soon the Hermann Kauls, too, le Sept. 30, Ai (LEAK LAKE will be self supporting. Soon le was mar- Movies, luncheon and a 3 =piece th ey'll undoubtedly have their own nn.; on Oct. orchestra are on the entertain- house. And soon this land will Peltier, years dies" pprarrtya o 'ber lhe la- th d Saturday Clear Lake proved to be a boon no longer be "strange" to them. night at the Legion Club. to "last fling" fishermen last week, Soon they'll be assets to the com- . Lare two The party, sponsored by the Vet netting crappies up to two pounds munity like the Teodors Kauls, +-991n and-eve a few walleves and north-_ right on down to having sons on Two The Minnetonka Herald Ratered as second class mailing matter, May 23rd, 1930, at the post office at Wayzata under the act of March 3, 1879 K G. GulUxson - _ _ _ _ _ Editor 1lebert Bushnell _ Advertising Manager Subscription Rate Per Year .................. ..........................$2.50 Outside of. Minnesota ......................... ............................... 3.00 Telephone Wayzata 1040 They Did It In Sheboygan! Residents of Sheboygan, Wisconsin became interested in a fluoride program when a survey revealed that school children in Green Bay; m, the fluoride area of the state, had 40 to 60 percent less tooth decay than Sheboygan children. At a cost of approximately $1,500, the city of Sheboygan installed equipment to artificially add fluoride chemicals to the city water supply. That' was over five years ago,- and a recent re- port of the operation by the Department of Public Health sum- marized results as follows: 1. In five years of fluoride operation no trace of discolor- ation or mottling has shown on the teeth and no toxic conditions have been noted. (Note:, Fluoridation has been objected to in some quarters since excessive amounts would produce mottled tooth enamel, if con- tinued for extensive periods. The U. S. Public Health Service, however, reports that on the basis of thousands of examinations, no instance of mottling has ever been observed among users of water containing 1.0 ppm fluoride. The Health Department has recently raised ' its -water, standards to permit fluoride content hp to 1.5 ppm.) 2. A somewhat higher luster or sparkle to the teeth is gradually appearing which adds considerably to the beauty of the enamel. 3. Recent surveys in young children show almost an entire absence of caries in the anterior teeth. (Note: Other surveys since 1941 claim that a fluoride content of between 1.0 to 1.5 parts per million may provide up to 66 percent reduction in dental decay, where' the water is used from birth through the first eight years of life.) In Minnesota, seven communities have followed Sheboygan's lead, and fluoridation programs for 13 more have been approved by the Minnesota Department of Health. Fluoridation of the Wayzata city water supply is on the council agenda of future improvements. Because of the nature of the improvement, however, council action must "await approval by the state department of health, local medical officials and a strong public demand. Two of these hurdles are already passed. The state health, department is in favor of fluoridation wherever local water sup - plies possess a fluoride content below 1.0 ppm. A poll of all local doctors and dentists found no opposition and much definite enthusiasm for the program. The rest is up to Wayzata residents themselves. Since the ball first started rolling, the Wayzata Woman's club has advised the city council of its support of the program. A scattered few individual residents have also urged that it be put into effect as soon as possible. But that isn't enough! If each organization within the community— businessmen, PTA, American Legion, church groups, etc. , will go on record and urge the council to put the fluoridation program into effect, our children 'can have this dental protection now being enjoyed in other communities. If addition of fluorides to our. city water supply is to benefit the present crop of little tykes in our community, the program must proceed without further delay. It is your responsibility. How about it? , pages, a to basic eternal that fir., from re., our the Two to these right her It wo It w materials i levers and output and' This The m other parts made it wo Of cou But as 1 Man Who ( hummed an( kept it clean There w Wanted forg manner the The Ma up, and he E his children, The Ma oversight. H make the Ha Pretty s among them Nobody They we Happiness, w very rusty. , I Working The Ma The Man W and less wor Who Could The Peo quantity of Poor Hap There wa the overall tro hired relatives . They did like they knew as monkeys would, A mechani name was War. and engage in I the same thing. . The People so they helped Tinto the Work by pul)an You should The mechan left. Then the di Machine started Wouldn't yc XVli Pn Pnrl - �• I. v ka Hera Id' fiaseetoN"" XY, FEBRUARY 14, 1952 10c Per Copy NUMBER 41 �3 �j E Beanstalk," vn's camera. :idds Jackie ad Jill Hoke, he ogre, Bob sent 9.ning r of the cast is �ide the school. 1, live hen who fifth and sixth g with the pro - Clark, Roger m Claridge are ng. fie, Mrs. Palma 't Cox, Miss State Reducing Debt, Bjornson Tells Rotarians. "Minnesota's all-time high state budget is sizeable enough," State Treasurer Val Bjornson admitted to Rotary club members and guests at their regular weekly meeting at Hart's cafe here Wed- nesday noon. But,"' the treasurer added, "even at our present high spending level, we could run the state of Minnesota for just a little more than 303 years on the 851/2 billions which the Truman 'federal budget de- mands for just . the single fiscal year, 1952 -53." City manager Earl Wagner in- troduced Bjornson. He has spoken here on a num- ber of earlier occasions as news Heart Attack Takes Life of Paul Nelson, 47 Many Wayzata people were shocked and grieved this past weekend to hear that Paul S. Nel- son, 47, had passed away of a heart attack while vacationing at Fort Meyers Beach, Florida. Mr. Nelson, who was former- ly associated with Mutual Trust Insurance company, moved to Wayzata with his family five years ago, and settled in the old Field home in Holdirdge. During his years here, he play- ed a large part in community af- fairs, endearing himself to a host of friends. An active member of Wayzata Masonic lodge, Nelson also held memberships in St. John's Chap- ter No. 9, Zion Commandery of the Knight Templar, Zuhrah tem- ple of the Shrine, and Minneapo- lis Athletic club. paper man and radio commenta- tor, but appearing now in the role of state treasurer —a post he has filled since January, 1951. Bjornson made his remarks to the Rotary audience something of a "report to stockholders" on state fiscal operations. "While our state debt is size- able in its total of 127 millions now," Bjornson said, "there are reassuring aspects when we take a second look. More than half that total debt is the veterans' bonus obligation, of which $67,- 200,000 remains unpaid. "About a fourth of the over- all total, some 28 millions, is what we still have to pay for our rural credit venture back in the twenties. "One `ray of light' in our grad- ual progress toward getting out of debt," the treasurer. added, "appears in our highway bond obligation. We will pay the last remaining installment of $650,000 now on the first of May. This spring, we will have wiped the slate clean of indebtedness fol- lowing a highway bond issue in the early twenties that totaled $40,150,000 at its outset, back in the days when we were `lifting Minnesota out of the mud' after adoption of the Babcock amend- ment." Bjornson said the most impres- sive development in his tenure of the treasurer's office so far had come in mid -June last year when the state's permanent trust funds passed the 200- million- dollar mark. "Those funds," he pointed out, "kept inviolate, care- fully invested, are earning for all of us an average of $14,000 a day in interest now, and they are contributing $8.70 per pupil toward our state school aids." F, MINUTES OF THE FLUORIDATION MEETING OF APRIL 12j, 1951 Dr. Bierman opened the meeting. He introduced Dr. Jordan, fluoride is added to water for a preventative purpose, it is oderless, colorless and tasteless. One case mentioned children in community had 1 /3rd less decay than before use of fluoride. Cited cases of various cities and the reduction of dental decay. Younger children receive the most benefit. Between $250.00 to $500.00 is approximate cost of pumps which are installed at source of supply. Approximate cost is 5 to 14 cents per capita or as Dr. Jordan stated the cost of one candy bar.. Neration should be checked daily. Dr. Jordan also mentioned that the dentists are backing this movement. Community must have an engineer to draw up plans, show type of equipment, place of installation etc. Can get assistance from water equipment companies. Edina has three sources of water supply or three wells. .Must remember that this procedure is a long range program. Sixty communities out in the state have installed this procedure. One is St. "Louis ,Park. Members present at the meeting were Dr. HerbertMcKay, Dr..Campbell, Dr. Bierman, Mrs. N,1. Crabtree, and Mrs.-HrS. Hoffert. Secretary Pro -Tem : Mrs. H. E. Hoffert D OR% The Wallace & Tiernan Ampero- metric Residual Recorder is an instrument for measuring and charting the residual chlorine in water. It operates by taking a small, con- . tinuous sample of the water to be tested, measuring a function of the residual chlorine in the sample, and 7 . 1 recording the results on a chart in parts per million. The recorder will measure either free available 777,�,l e ® residual chlorine or total residual chlorine. Today the Recorder is giving progressive plants throughout the country these benefits: • Better Chlorination Control pat m • Check on General Plant Operations Y� r ' • Permanent Record of Water Quality • Determination of Chlorine Demand • Reduction of Chlorine Wastage by Avoiding Over Treatment The actual charts reproduced on the following pages are typical examples of how these advan- tages are achieved. WALLACE & TIERNAN The first step toward amperometric recording of residual chlorine was the development of the W & T Amperometric Titrator. With the Titrator, residual values can be measured to the nearest hundredth part per million. This accuracy is not affected by interfering substances and high turbid - ities which do affect measurements by colorometric methods. Different types of residual chlorine — free, combined or total —can be accurately differ- entiated with the Amperometric Titrator. The charted residual values on the Residual Chlorine, Recorder are set and regularly checked with the Amperometric Titrator which is furnished with each Recorder. M % M"- , 11 CHARTS �.ls1�1�b A.,Ol�7o;,o I at a water plant adding carbon in the settling basin The physical layout of this plant consists the effect of an increased demand and of an impounded s I I a settling accounts for the . variation in residual p IppY• 9 basin, pressure filters and high lift indicated on the Recorder Chart. pumps. The treatment involves pre - chlorination and alum feed at the inlet With the Residual Recorder as a guide, of the settling basin, the addition of chlorine feed rates can be periodically carbon midway in the settling basin, changed to compensate for the varying and postchlorination at the high lift effects of the carbon coatings. pump suction. How the Residual Recorder helped this During a normal 12 hour filter run, the plant . . . pressure filters become coated with carbon. The carbon coating, which acts as a dechlorinating agent,. is reduced by backwashing the filters. This gives O Improved Chlorination Control O Checked on Operation of Chlorinators O Improved Water Quality, O Reduced Wastage of Chlorine CHARTS U�11 eg 0 U O M T O 0 O O at a Large indoor swimming pool The operators who run this pool were unable to keep the residual chlorine where it ought to be and were getting complaints from the swimmers at times and from the medical authorities at other times. Before the Residual Recorder was installed, their periodic residual tests gave no indication of what was happening to the residual chlorine in the pool. During the first weeks of Recorder op- eration at the pool, the chart gave the operators a pattern of the residual chlorine in the pool at all times. They were surprised how well the chart showed them what happened to the residual when different size groups of swimmers used the pool. Very shortly they learned the amount of residual chlorine necessary in the pool at the beginning of the day to maintain a safe chlorine content throughout daily pool usage. The operators were pleased —they ,had only to adjust the chlorine feed ,rat e once or twice a day instead of every few hours. The swimmers had only to take one look at the chart, then swim with assurance. Why pools need a Recorder . . . o For Simplified Pool Operation o. To Provide a Permanent Record o For Continuous Protection Against Infection o As Added Confidence of Safety for Swimmers CHARTS 0 at a plant getting water from three sources A W & T Residual Recorder was installed in a city which has three water sources: —a spring supply which is chlorinated in the clear well; a second spring supply which is chlorinated at the source; and a creek supply which is pre - chlorinated before filtration. These supplies are combined before distribution. During the first few days of operation the Recorder Charts showed that the residual chlorine was always sufficient but was erratic and very often greatly in excess of what was needed. After the charts had pointed out the operational difficulties, steps were taken to obtain better control of chlo- rination. The resulting charts indicated sufficient residual at all times, but never too much. Today, with the in- creasing cost,and shortage of chlorine, the chlorine saved is an jmportant factor at this plant. What the Residual Recorder accomplished . O Improved Chlorine Feed Control o Reduced Chlorine Use O Uniform Water Quality o Provided Permanent Record of Chlorination . CHARTS at a power plant An accurate record of chlorination was lacking at a large power plant. Here chlorine was applied by means of inter- mittent treatment for slime control on the condenser water -side surfaces. Since the chlorinator starts automati- cally and runs only for a short period, it was often difficult for plant operators to make a residual test. Besides, the residual chlorine tests they were able to make varied considerably, indicating changes in the demand of the cooling water. The W & T Residual Chlorine Recorder charted a continuous record of the residual chlorine. After this it was not necessary for an operator to take time out to check the residual when the chlorinator was in use. Any irregulari- ties in the operation of the chlorinators could be immediately spotted on the recorder charts. The Residual Recorder also served to indicate changes in the chlorine de- mand. If the rate of chlorine treatment remained the same for several cycles, any changes in the recorded residual chlorine from one cycle to the next would be indicative of a change in the chlorine demand. How the Residual Recorder aids power plants . . . • Reduces time necessary for manual residual testing • Gives Continuous Recording of Residuals • Produces Charts for' Permanent Record • Check on. proper Operation of Chlorinators C , a a 7, N, CHARTS t' 19, WO d"O 0 at an industrial plant An eastern yeast manufacturing plant found it essential 'to sterilize all the plant water to prevent infection in, the yeast. Too little residual chlorine did not give sufficient protection —too much chlorine could injure yeast strains. Startling results were disclosed by the First chart, as may be seen. Because of the extreme variations of the residual chlorine in the process water, steps were taken by the plant operators to correct the situation. After they learned to F regulate the chlorine feed with due regard for lags in the residual follow- ing changes in water flow, the charts showed approximately the same resid- ual throughout a 24 hour period. Here is what the Recorder did . . . • Improved Chlorine'Control • Resulted in Better Control of Product Purity • Gave Permanent Record of Chlorination • Simplified Control of Chlorine for Maximum Benefits �j 0 July 25, 1951. Dr, Claude W.. Bierman Chairman. of Fluoridation Cowdttee 3M Physicians & Swzeons ceding Hirmspolieg Minnesota Dear Dr. Bierman: At the dk,Zty 23 meeting of the MUalSe Council, your Comm tteel s report of April U me dis=ssed at Mme length. The action of the Coonc3.l was as foUowss O$redeson =wed that Council go on reccrd as ftroring the . Invtallation of equ#ment for a fluoride prooram, and instructing the Village eng#.nser to ate s survey of pient necessary for such a program and report back to Council so that bide m4W be taken for same, and that Fluoridation Camm ttee be notified of this action. Motion. seconded by Hawthorne and carried.0 ate mill ,notify you as soon as fbrther action is takmo Yonne very trays VIIJAM OF EDINA BY Dy, ce ;. Dr' L. H. C=Oell iir. Herbert McKay Mrs. go L. Crabtree Mre. Ii. E. Roff err, Mr: P.. Theo. Mason mr. Ben Woehes BY Dy, 25, 1951. Der. C] "O W. Rier= t ChArma ► of pluorldatiaa Ccm'iatee 3M Pb7siciane & svr�,,eons Napoli®, KInneaots Dear Dr.. Bieren : A the July 23 Meetln�n of the lace ll your CCMAltteel a report, of,: APrIl 3A wo di ced 'at sous lath. - Thq ec %n of the CaimajI. Was as fanovet aDredeson XoVad ti, .6t • Ga=il co an record as favoring that.' Instanation of equipment for a nuo a proms,. and instn nE the VMK9 en eer to e a W of egniSm ntaeee� rcm eZro h a proSoaa and report back to .Comcil. so tbat blots =q be taken for same, and that nuoridation Co=ittec be =U sied of this action, ? "atim secoaded by, Howthorn.+e and carried. Ica do notiry you as soon asfwther activm is, tak en. ' YOUX4 Very trc40 n A (W MUM Dft7aT VILU'ru CIA*.. .: cc; Dr. I. !)r. flerba t �IaK ors. 11, iw. Crabtrea i�rs. H. �. Hof3e3rE Hr. F'. Theo. tI== f. Bar; woe la MINUTES OF TFE PLUCRIDATICH pI� -MM CP AML-120 1951 Dr. Bierman opened the meeting. He introduced Dr. Jordan# fluoride is added to water for a preventative purpose, it is oderless, colorless and tasteless, ane.case mentioned children in caammunity had 1 /3rd less decay than before use of fluoride. Cited cases of various cities and the reduction of dental decay. Younger children; ^receive the-most benefit. Between 8250.00 m to $500.00 is apprmd�te cost. of pumps which are installed at source of supply. Approximate cost is 5 to 14 cents per.capita or as Dr. Jordan stated the -cost of one,candy'bar. Operation should be checked daily. Dr. Jordan also mentioned that the dentists Ore backing this movement. Commodity must have an engineer to draw up- plans, show type of equipment, place of installation etc. Can get assistance from grater equipment companies. Edina has three sources of water supply or three wells. Must remember that this procedure is along range program.= Sixty ca=iu Aties out in the state have installed this procedure. One is St. Louis Park. Members present at the meeting were Dr. HerbertMcKay, Dr. Campbell.. Dr. Hierman, Mrs. W.L. Crabtree, and Mrs. HE. Hoffert. Secretary Pro -Teas s Mrs. H. E. Hoffert 1 I FOR ENGINEERIS REFERENCE RECORDS. The primary producers of sodium fluoride are: 1. Aluminum Company of America, Pittsburgh, Pa. (Sell exclusively through: Du Pont, Wilmington, Del. . American Cyananid, New York; Thompson- Haywardv Kansas City, Mo.; Ferro - Enamel, Cleveland, Ohio.).. 2. Blockson Chemical Company, Joliet, I11. 3. Allied Chemical & Dye Corp.; General.Chemical, New York City. The primary producers Of sodium silicofluoride are: 1. American Agricultural Chemical Co., New York City (Sell exclusively through Henry'Sundheimer Co. New York.City. 2. Baugh & Company, Baltimore, Md. 3. U.S. Phosphoric Products Inc. ;Div. of Tennessee Corp.; Tampai Florida. k. Blockson Chemical Company, Joliet, Ill.; 5. E. I Du Pont de Nemours.and Co.; Grosselli Chemicals Dept.) Wilmington, Del. F' rj February 19, 1951 Edina- Morningside Courier 418 South Third, Street,( Minneapolis 15, Minnesota Gentlemen: Will you, please give some publicity, in your issue of the 22nd, to the followings Itapor.Reuben F. Erickson has this creek appointed the following committee of seven for a study of the desirability of fluorination of the Village drinking water, with view toward eliminating tooth decay in children;. Dr. Claude: W; 'Bieiman, Chairman. (4532 Casco Ave.), Dr. Lowell K. Campbell (4500 Edina Blvd.) Dr. Herbert :D. McKay =- (4615 Wooddale 1►ve.) ,Mr. P. Theo. Olsson (4601 Drexel Ave*) Mr..Ben Woehler: (4532 W. 56th-St.) Mrs. R.E,.Hoffert (4624 Wooddale Ave.) . Mrs, Nate Crabtree (5508 Concord Ave.) (For your information, Dr. Campbell is Village health Officer, Mr. Olsson'ia Village Vanager,,and Mr. Ben Woehler is Village Public Utilities Supt,) Committee has no. yet met, as of this date. You rs . very. truly, VILLAGE OF ED IRA BY Deputy Village Clerk gsa February lb, 1951 ffi-. Burke Suburban Press; 6th Ave. go. Hopkins, Minn. Dear Mr. Burke: Will you please give eotae publicity, in your Issue of. the 22nd, to the following: Mayor Reuben F. Brick: on has this week appointed the following committee of -seven for a study of the desirability of fluorination of the .Village drinking wat ®r, with view toward eliminating.tooth decay in- children::. Dr. Claude W. Bierman, Chairman (4532 Casco Ave.) Dr. Lowell 24. Campbell (4500 Edina Blvd, Dr. Herbert L. McKay (4615 Wooddale Ave.) Mr. F. Theo. Oisson (4601 Drexel Avs.) Mr.' iioehler 4532 W. 56th Sid. ) Mrs. H.E. Fioffert N24 Wooddale Ave.) Mrs. Nate.Crabtree (5508 Concord Ave.) � (For your information, Dr. Campbell Is Village Health Officer,.; Air.'Olsson is Village.Manager, and Mr. Ben Woehler Is Village Public Utilities Supt.) Cor_unittee has not yet met, as of this date. Yours very truly, VILLAGE 'OF. DZNA BY Deputy Village Clerk 1. . gea r Minneapolis 10, Minn. Dear 'Dr. Campbell: . As of :February 3, the Edina. Tillage Council has authorized me to appoint a citizens committee to make a.study of the desirability of tluorination•of our drinking water. I have asked Dre Claude Bierman to serve as Chairuan of this Committee,. and'- he has accepted. I am taking the liberty of appointing you as a member of the Committee, and I trust that you will find it possible to accept the appointment., Dr. Bierman -will get in touch with you very soon, and he will explain in more detail the Committee's function. Sincerely, M wor VILLAGE OF .EDINA < , RFR*gso Committee Roster, as we received it from-Dr. Erickson is as follows: Dre Claude 14o Bierman„ 4532 Casco Ave. -'WK. 2507 _ Dr. Lowell 14. Campbell, 4500 Edina Blvd, ® WA. 0994_(Villagb Health Officer) Mr. P.Theo. Olsson, 4603 Drexel Ave. - WA. 9762.(Village'14anager & Engr, Mr. Ben Woehler- 4532.. 456th St. - WH. 0810 (Village Public Utilitie Supt•) Mrs. H. E. Hoffert- 4624 Wooddale Ave. -WA. 8989 -' Mrs.- Kate Crabtree 5508 Concord Ave. _wm. 6383 Dr. Herbert'D•. McKay 4615 Wooddale AVree -WA, 7808 Messrs. Olsson and 1-loehler may be reached at the Village, Hall, WH 16661p during the day. / f � I February 1$,.1951 Mr, P, Theo. Olsson,`Manager Village of -Edina 4801 We' 50th Street Minneapolis 10. Minn. Dear Mr.• Olsson: As of February 3, -the Edina.Village Council has authorized me to appoint a. citizens committee to make a study of the desikability of fluorination of our drinking Crater. I have asked Dr,, Claude Bierman to serve as Chairman of this Committee, and he has accepted.. I am taking the liberty of appd nting,you'as a member of the Committee,, and I trust-that you will find: it possible to accept the appointment., a Dr. Bierman will get in touch with you ve17 soon, and he will. explain in more detail the Committeets function. Sincerely, Mayor VILLAGE OF EDINA" riFlPttsmn February 15, 1951 Kr. Ben' Woehler Edina Public-Utilities Supt. 4801 W. 50th Street Minneapolis 10, Minn. � Dear Mr, Woehler: As of February•3,'the Edina Village Council has authorized me to appoint a citizens comittee to make a,study of the desirability of fluorination of our drinking water. I have asked Dr. Claude Bierman to serve as Chairman of this Committee, and he has accepted. I am taking the liberty of appointing you as a ®r --of the Committee, and I trust that you will find it possible to accept the appointment. Dr. Bierman will get in touch with you very soon, and he will explain in more detail the Coagaittee' s function. Sincerer, Mayor \ VILLAGE OF EDYNA igsa February 15, 1951 Krs. Nate Crabtree 5506 Concord. Avenue Minneapolis 10, Minn. Dear Mrs. Crabtree:. As of February 3, the Edina Village Council has authorized me to appoint a citizens committee to make a study'of the desirability of fluorination of our drinking water. I•have asked Dr. Claude Bierman to serve as'Chairman of this Committee, and he has accepted. I am taking the liberty of appointing you as a member of the Committee, and I trust that you will find it possible to accept the appointment. Dr, Bierman will get in touch with you very soon,-and he will explain in more detail the Committeel's function, Sincerely, Mayor, VILUO OF EDINA. , February 15, 1951 lop Dr, Herbert D. McKay 4615 Wooddale Avenue: " Minneapolis 102, Minn. Dear Dr, McKay: As of February 3,.the Edina Village Council has authorized me to appoint a- citizens committee to hake a'study of the desirability of fluorination of our drinking orator. I have asked Dr,'Claude Bierman-to serve as Chairman of this Committee, and he has accepted. -.I am taking the liberty of appointing,you as a member of the Committee, and L.trust that you will find it possible to accept the „appointment. i Dr. Bierman gill get is touch ®dth.you' very soon, and he will ;;;lain in more detail the Committeets function. Sincerely, Mayor, VILLAGE OF EDINA BFE*gea i • .r February 15, 1951- Drs. H. E�. Hof fert 4624 Wooddale- Ave Minneapolis 10s Minn. Deai< Mrs. Hoffert: As of February 3, the Edina Village Council has authorized me to - appoint a citizens committee to make a study of the desirability of fluorination of'our drinking `rater. I have asked Dr. Claude Bierman to serve as Chairman of this Committee, and he has accepted. I am taking the liberty of appointing you as a member of the Committee, and I trust that you will find it possible to accept the appointment. - Dr, Bidrman will get in touch with you very soon, and he will explain in more detail the Committees 'function. Sincerely, 2pyor VILLAGE OF MINA RFE*gse r i DR. CLAUDE W. BIERMAN Y MINNEAPOLIS 3 63 KYSIcIans $ Surgeons Dr. Reuben Erickson Mayor of Edina Village Edina, Minnesota Dear Sir: April 16, 1951 The Committee you,appointed to study the fluoridation of the water supply for Edina met on the evening of.April 12, 1951. All members but two of this committee were pre- sent. Dr. W. A. Jordon of the Dental Health Division of the Minnesota Department of Health was invited to tell us about the progress already-made-and being made throughout our state and neighboring states in the fluoridation of drinking water. His report was very interesting and after a lengthy discussion, your committee decided unanimously to submit the following resolution to you and the members of the Edin_Xoun- cil. Whereas, accumulated evidence indicates a sound basis for the fluoridation of public water supplies for the partial control of dental caries, therefore, be it resolved, that this proceedure be recommended as a safe and effective method for reducing the prevalence of dental cartes. Dr. L.M. Campbell Dr. Herbert McKay Mrs. N. L. Crabtree Mrs. H.E. Hoffert S' gned b D Dr. C. W. Bierman .Chairman 7, -� 1 i oof LT _r 4 1 J J / i / -- C �CQ �. _ V / MWES OF THE FLBORIDATI0N 1� 5 :TEM OF APRIL. 12, 1951 Dr. Bierman opened the meeting., He introduced Dr. Jordan, fluoride is added to water. for a preventative purpose, Wis _bderless, colorless. and tasteless. One case mentioned -children -in coamnurdty'had 1 /3rd less decay than before use of fluoride. Cited cases of various cities and the reduction of dental decay. Younger children receive the most benefit. Between 8250.00 to 9500.00 is approximate cost of pumps which are installed at source*of supply. Approximate cost is .5 to 14 cents per capita or as Dr. Jordan stated the cost of one candy bar.. Operation should be checked daily. Dr. Jordan also mentioned that the dentists are backing this movement. Community must-have an engineer to drag up plans$ show type of equipment, place of installation etc. Can get assistance from crater equipment companies. Edina has three sources of water supply or three wells. ?dust remember that this procedure is a long range program.. Sixty communities out'in the state have installed this procedure. One is St. Louis Park. Members present at the meeting were Dr. Herberthc$ays Dr.'Campbell.. Dr. Bierman$ Mrs. N.L. , Crabtree$ and Mrs. HE. Hoffert. .FOR ENGINEER'S REFERENCE RECORDS. The primary producers of sodium fluoride are:' 1. Aluminum Company of America, Pittsburgh, Pa. .(Sell.exclusively through: Du Pont, Wilmington, Del. American Cyananid, New York; Thompson— Hayward, Kansas City, Mo.; Ferro— Enamel, Cleveland, Ohio.) 2. Blockson Chemical Company, Joliet, Ill. 3, Allied Chemical & Dye Corp.; General Chemical, New York City. The primary producers Bf sodium silicofluoride are: 1. American Agricultural Chemical Co., New York City (Sell exclusively through Henry Sundheimer Co. New York City. 20 Baugh & Company, Baltimore, Md. 3. U.S. Phosphorie Products.Inc.;Div. of Tennessee Corp.; Tampa, Florida. 4. Blockson Chemical Company, Joliet, Ill. 5. E. I Du Pont de Nemours and Co.; Grosselli Chemicals Dept., Wilmington, Del. 1 o - - I VILLAGE OF EDINA 4801 WEST FIFTIETH STREEIT •I EDINA, MINNESOTA f February 15, 1951 it i I Mr. P. Theo. Olsson, Manager Village.of Edina 4801 W. 50th Street Minneapolis 10, Minn, Dear Mr. Olsson: As of February 3, the Edina Village Council has authorized me to appoint a citizens committee to make a study of the desirability of fluorination of our drinking water. I -have asked Dr. Claude Bierman to serve as Chairman of this Committee, and he has acceptedi1 I -am taking the liberty of appointing you as a member of the Committee, and I trust that you will find it possible to accept the appointment. Dr. Bierman will get in touch with you very soon, and he will explain in more detail the C011mittee's function. rely, yor i VILLAGE OF EDINA. RFE*gsa